Fat necrosis in the Breast: A systematic review of clinical

Vasei, Narges; Shishegar, Azita; Ghalkhani, Forouzan; Darvishi, Mohammad

doi:10.1186/s12944-019-1078-4

Cited by 34 publications

(36 citation statements)

References 53 publications

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“…Fat necrosis is a complication causing symptoms in the patient and sometimes requiring biopsy to differentiate it from malignancy. Fat necrosis occurs from 4.6 to 100%, depending on the surgical procedure [16,17]. Our surgical method reported a lower fat necrosis rate (3.4%) than that of traditional BCS because it either did not make or minimized pedicled fat flap.…”

Section: Discussionmentioning

confidence: 81%

Volume replacement with diced acellular dermal matrix in oncoplastic breast-conserving surgery: a prospective single-center experience

et al. 2020

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Background: Several studies have reported the use of acellular dermal matrix in breast reconstruction. However, the primary role of acellular dermal matrix in these studies was to support the implant; there are no reports on the use of acellular dermal matrix exclusively as volume replacement. Thus, we aimed to evaluate the safety and effectiveness of filling of the defect with acellular dermal matrix in oncoplastic breast-conserving surgery. Methods: We prospectively recruited 120 adult breast cancer patients who were scheduled to undergo oncoplastic breast-conserving surgery with acellular dermal matrix filling from 2017 to 2018. Intraoperatively, diced human acellular dermal matrix measuring 3-5 mm was used on each side to fill in the excisional defect immediately. After 6 months, satisfaction of the patients and surgeons with overall and cosmetic outcomes was evaluated with a survey using a 10-point scale. Postoperative complications were assessed at 2 weeks and 6 months postoperatively. Results: Of the 117 patients who were evaluated for their satisfaction, 94.0% were strongly satisfied with the cosmetic outcomes and 90.4% were strongly satisfied overall. Patient overall satisfaction scores were higher than surgeon satisfaction scores (p < 0.001). Of the 117 patients who underwent evaluation of complications 6 months postoperatively, six (5.1%) had hematoma and seven (6.0%) had seroma. The overall reoperation rate due to complications was 8.5%. Only two patients needed acellular dermal matrix removal due to hematoma and inflammation. Conclusion: Oncoplastic breast-conserving surgery with acellular dermal matrix filling of defects can be performed safely with high cosmetic satisfaction.

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Section: Discussionmentioning

confidence: 81%

Volume replacement with diced acellular dermal matrix in oncoplastic breast-conserving surgery: a prospective single-center experience

et al. 2020

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“…Hassan et al [10] studied the specific imaging features of fat necrosis and concluded that the presence of fat signal intensity within the lesion on unenhanced MR images had sensitivity of 98.04%, specificity of 100%, PPV of 100%, and NPP of 96.88%. Vasei et al [3] stated that fat necrosis usually appeared isointense to the fat elsewhere in the breast, it appeared of high SI on T1WI and hypointense on STIR images when compared with the surrounding fat, and this is known as the black hole sign. This is concordant with our results where the presence of fat SI within the lesion had 100% sensitivity, 90.9% specificity, and 96.2% accuracy in differentiating fat necrosis from recurrent breast carcinoma.…”

Section: Discussionmentioning

confidence: 99%

“…Surgery and radiation therapy made treated breast prone to several modifications. This can complicate the interpretation of ultrasound and mammographic images, especially when local recurrence is suspected [3].…”

Section: Introductionmentioning

confidence: 99%

Detection of recurrent breast carcinoma using unenhanced breast MRI

EL-Adalany

EL-Metwally

2020

Egypt J Radiol Nucl Med

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Background: Early detection of locally recurrent breast carcinoma has been shown to significantly improve longterm survival. Surgery and radiation therapy made treated breast prone to several modifications. This can complicate the interpretation of ultrasound and mammographic images, especially when local recurrence is suspected. The aim of this work is to assess the role of unenhanced MRI (T1WI, T2WI, STIR, and DWI) in differentiating recurrent breast cancer from benign post-operative lesions. Results: The presence of fat SI within the lesions had 100% sensitivity, 90.9% specificity, 94.1% PPV, 100% NPV, and 96.2% accuracy in differentiating fat necrosis from recurrent breast carcinoma. A cutoff ADC value of 1 × 10-3 mm 2 / s for observer one had 80% sensitivity, 90.9% specificity, and 88.9% accuracy in diagnosis of recurrent breast carcinoma. For observer two, a cutoff ADC value of 1.25 × 10-3 mm2/s had sensitivity of 80%, specificity of 88.6%, and diagnostic accuracy of 87.03% in differentiating recurrent breast carcinoma from benign post-operative changes. Unenhanced MRI had 81.8% sensitivity, 97.7% specificity, 90% PPV, 95.5% NPV, and 94.5% accuracy in the diagnosis of recurrent breast carcinoma. Conclusion: Unenhanced MRI including T1WI, T2WI, STIR, DWI, and ADC map had high sensitivity, specificity, and diagnostic accuracy in diagnosis of recurrent breast carcinoma and differentiating it from benign post-operative changes.

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“…However, one of the extremely rare causes of fat necrosis is calciphylaxis, which is a calcification of small‐ and medium‐sized arteries leading to the development of intramural thrombus and subsequent ischemia. Calciphylaxis has been reported in the literature to be encountered in different parts of the body like skin, kidneys, muscles, and to a lesser extent in lungs, heart, and alimentary tract 1–4 . It is classified into (A) uremia‐induced and (B) nonuremic‐induced calciphylaxis (obesity, chronic liver disorders, and drugs) 5 .…”

Section: Introductionmentioning

confidence: 99%

Breast fat necrosis secondary to warfarin‐induced calciphylaxis, a rare mimicker of breast cancer: A case report and a review of literature

et al. 2021

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Breast fat necrosis (BFN) is usually a benign inflammatory response to breast trauma. However, an extremely rare cause of fat necrosis is calciphylaxis, a calcification of small‐ and medium‐sized arteries causing thrombosis and ischemia. It is classified into (A) uremic (B) nonuremic‐induced calciphylaxis. Calciphylaxis has been reported to be encountered in different parts of the body. However, to the best of our knowledge there is only one case in the English literature of BFN 2ry to warfarin‐induced calciphylaxis. We report a 65‐year‐old female, known case of atrial fibrillation on warfarin, presented with a left breast mass of 4‐month duration. The mass was painful and progressively enlarging. Examination of the left breast showed 7 × 4 cm mass, spanning from 10‐2 o'clock, free from surrounding structures, with preserved overlying skin. However, the mass was not visualized on mammogram. Ultrasound showed a left breast lobulated hypoechoic mass containing a hyperechoic component. Biopsy showed fat necrosis. After 1 month, she presented with ulceration of the overlying skin. After wide local excision, histopathology demonstrated a calciphylaxis‐induced fat necrosis. Considering the patient's background, the diagnosis was BFN secondary to warfarin‐induced calciphylaxis. Hence, the warfarin was shifted to Rivaroxaban, 6 months follow‐up showed no evidence of recurrence. In conclusion, the rarity of nonuremic calciphylaxis is reflected on the delay of diagnosis in some of the reported cases and the lack of grading system used to guide the management of such difficult wounds. However, keeping a high index of suspicion is important whenever such wounds are encountered with presence of risk factors other than end‐stage kidney disease.

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Fat necrosis in the Breast: A systematic review of clinical

Cited by 34 publications

References 53 publications

Volume replacement with diced acellular dermal matrix in oncoplastic breast-conserving surgery: a prospective single-center experience

Volume replacement with diced acellular dermal matrix in oncoplastic breast-conserving surgery: a prospective single-center experience

Detection of recurrent breast carcinoma using unenhanced breast MRI

Breast fat necrosis secondary to warfarin‐induced calciphylaxis, a rare mimicker of breast cancer: A case report and a review of literature

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