Sonography of fat necrosis of the breast: Correlation with mammography and MR imaging

Abstract

Fat necrosis (FN) of the breast is a benign nonsuppurative inflammatory process of the adipose tissue. The radiologic appearance ranges from benign to suspicious for malignancy; therefore, it is very important to know the distinguishing radiologic features of FN on different modalities. Mammography is more helpful in identifying FN than ultrasonography in most of the cases, and MRI may also be used to rule out malignancy as an adjunct to mammography and sonography. Even when modern diagnostic modalities are used, biopsy may still be unavoidable for some cases. In conclusion, an accurate history and familiarity with the radiologic findings are crucial to recognizing FN and avoiding unnecessary interventions.

Lipofilling Outcomes Mimicking Breast Cancer Recurrence: Case Report and Update of the Literature

“…The presence of calcifications on mammographic examination may lead to a suspicion of breast cancer relapse, especially at the first stage of the process when the calcifications present small size (17,18). The imaging findings on US examination may be misleading, presenting as a structural inhomogeneity of the subcutaneous fat tissue or a hypoechoic aspect with blurred margins and posterior acoustic shadowing (16). In our experience, the breast US finding of structural modification and the presence of multiple hypoechoic areas with blurred margins and acoustic shadowing, together with the MRI finding of multiple enhancing nodules, led us to a high suspicion for cancer relapse (19).…”

“…The most frequent complication was liponecrosis. Among different studies, the incidence of fat necrosis was, however, extremely variable, also depending on the lipofilling technique used (15)(16)(17). Usually liponecrosis is asymptomatic, sometimes patients may present local ecchymosis or a palpable mass.…”

“…Usually liponecrosis is asymptomatic, sometimes patients may present local ecchymosis or a palpable mass. On mammographic examination, liponecrosis may appear as a radiolucent rounded image surrounded by a thin radiopaque rib (16,17). The presence of calcifications on mammographic examination may lead to a suspicion of breast cancer relapse, especially at the first stage of the process when the calcifications present small size (17,18).…”

Natural Course of Fat Necrosis After Breast Reconstruction: A 10-Year Follow-Up Study

“…Although solid lesions typically have well-circumscribed margins, they occasionally have indistinct or spiculated margins mimicking carcinoma (18,(25)(26)(27)(28). Cystic lesions appear as complex cysts with a mural nodule, complex cysts with echogenic bands, or round anechoic lipid cysts (29,30). Breast MR imaging of fat necrosis also shows a wide range of ndings.…”

“…Enhancement can be focal or diffuse and homogeneous or heterogeneous. Furthermore, enhancement patterns may vary from slow, gradual enhancement to rapid enhancement, and a washout curve may be present (13,25,29,31).…”