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fat necrosis

Riverajoe3
Riverajoe3 Member Posts: 3

I was diagnosed with breast cancer back in December. I had lumpectomy in January and started radiation 8 weeks later. During radiation i felt like I did pretty good besides the sunburn like feeling and look. I felt i was recovering good. Now in the last couple of months i been in really bad pain. It feels sore under my breast and certain movements brings a sharp pain. My boob became lumpy and some weird spot by my nipple which I google and said it is called fat necrosis. I called my radiation dr and he said he heard of it but its not from radiation and due to covid my surgeon and oncologist cant see me for over a week. Has anyone had or heard of fat necrosis on there breast after breast cancer?

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Comments

  • ctmbsikia
    ctmbsikia Member Posts: 749
    edited December 2020

    The 3 main causes of fat necrosis: Surgery, radiation, and injury. So yes, it can happen. Good that you're getting it checked. It will show up on imaging, it may require a shorter interval follow up, and perhaps even a biopsy to confirm that's what it is.

  • Riverajoe3
    Riverajoe3 Member Posts: 3
    edited December 2020

    thank you

  • peggysmom
    peggysmom Member Posts: 30
    edited December 2020

    Fat necrosis is common after ANY trauma to the breast (including post-surgical changes/lumpectomy). It also appears very classic on imaging. Nonetheless, you can evaluate this newly palpable lump with mammography which can easily confirm if what you are feeling is indeed fat necrosis.

  • moderators
    moderators Posts: 7,693
    edited December 2020

    Welcome, Riverajoe3. We're so sorry that you're dealing with this, setbacks in your recovery are always hard to process. Please keep us posted on what you find out when you're able to see your medical team!

    The Mods

  • beesie.is.out-of-office
    beesie.is.out-of-office Member Posts: 1,435
    edited December 2020

    Riverajoe, yes, what you are noticing could be fat necrosis.

    The good news is that fat necrosis is harmless. The bad news is that on mammogram imaging, while sometimes fat necrosis can be easily identified, other times fat necrosis can mimic the appearance of cancer. So while this hopefully won't be the case, a biopsy may be required depending on how the mass appears on imaging. I am someone who in fact did have to have a core needle biopsy one time for a lump that turned out to be fat necrosis. So that's not to scare you but to warn you... even if a biopsy is needed - and hopefully it's not - this still could be something completely benign and harmless like fat necrosis.

    What is Fat Necrosis? https://breast-cancer.ca/necrofat/


    "Fat necrosis forms into a lump or pseudo-mass due to fat cells that have either died or been damaged. A mammogram will easily detect this mass.

    The only concern is that sometimes the shape and features of a fat necrosis pseudo-mass can be very similar to certain kinds of breast cancer.

    Fat necrosis tends to have an irregular or rounded outline. Furthermore, these lumps tend to be smaller in size than other types of masses, usually less than 2cm in diameter."


  • peggysmom
    peggysmom Member Posts: 30
    edited December 2020

    Beesie- typically fat-necrosis has a slam-dunk appearance. In real life it does NOT usually pose a challenge in differentiating from cancer. Once in a while, sure, it get's biopsied. But in general this is an imaging diagnosis.

  • beesie.is.out-of-office
    beesie.is.out-of-office Member Posts: 1,435
    edited December 2020

    peggysmom, are you a Breast Radiologist?

    I provided a link and quote from a Breast Radiologist. I have personal experience in that I had a mass that had the appearance of cancer but turned out to be fat necrosis. And I've been hanging around here long enough to have seen many others who've had the same experience. Yes, hopefully if Riverajoe's mass is fat necrosis, it will be clear on the imaging. But to say that a mammogram will "easily confirm" if a mass is fat necrosis is setting an expectation that might not be met, as my own experience shows. As I said in another post, we always need to be careful when making definitive statements, because not much about breast imaging and diagnostics is definitive.

  • peggysmom
    peggysmom Member Posts: 30
    edited December 2020

    I am a breast radiologist

  • beesie.is.out-of-office
    beesie.is.out-of-office Member Posts: 1,435
    edited December 2020

    peggysmom, Good to know.

    We've certainly been missing djmammo these past few months, with a few of us trying to fill the gap. Of course it's a different role when fellow patients are offering advice and our thoughts about someone's situation based on our experiences and learning, vs. someone who is professionally trained. djmammo's presence and knowledge was invaluable, as I'm sure your presence will be, if you continue to post. I always found it interesting that in his responses, djmammo was much less specific and direct than any of the rest of us would be. Over time I've learned from that and try to follow his approach.

  • ctmbsikia
    ctmbsikia Member Posts: 749
    edited December 2020

    Does fat necrosis ever resolve on its own? Mine was biopsied in Jan. of this year. Any idea how long I have to see this thing on imaging? If it's forever I may opt to have it removed. Although that starts the risk all over again. While I am glad to know I have this and not a recurrence, I am striving to get this behind me and get to annual check ups. I am due for MRI in Jan. Last Mammo Sept. has put me back to a Birads3. It's a little frustrating. I assume the biopsy took most of it out, there's still 0.9cm or so showing up. Lord knows what it'll look like with contrast. TIA for any advice.

  • beesie.is.out-of-office
    beesie.is.out-of-office Member Posts: 1,435
    edited December 2020

    peggysmom, question from me as well.

    When I had my biopsy for fat necrosis, it was 20+ years after I'd had a couple of excisional biopsies on that breast. The fat necrosis had never shown up on my imaging before, and it was in the same location as those previous surgeries. I always wondered if the surgeries could have been the cause of the fat necrosis, all those years later. Can fat necrosis develop many years after a breast surgery, or was there perhaps some other trauma (that I wasn't even aware of) that caused it?

  • minustwo
    minustwo Member Posts: 13,004
    edited December 2020

    So PeggysMom - have you also had breast cancer? We always welcome another professional who's wiling to post & answer questions. I know the Mods will be glad to know there's someone else on board while djmammo is on hiatus.

    Edited to say - sorry I see you are getting ready to undergo reconstruction. It would help if you go to "my profile" and put your diagnosis & treatment to date so we understand where you are.

  • peggysmom
    peggysmom Member Posts: 30
    edited December 2020

    Hi all. To be perfectly honest, I came to this site seeking solace and wanting to connect with people as a "human" not a breast imager. Maybe it's selfish, but I am here as a patient. Am happy to help out, but really wanted to keep the focus on figuring out how to move forward with my own decisions.


    That being said- Fat Necrosis evolves and what it looks like on imaging depends on where it is on the timeline. We see fat necrosis multiple times on a daily basis, it's common! It can be seen from setting ranging from seatbelt injury to post-surgical changes following breast conserving surgery. It doesn't have to be a big trauma, one of the most common scenarios believe it or not is people with large dog/dogs that jumps up on their chest. Most people can't recall an inciting minor trauma!

    Fat necrosis can be seen on all modallities, including MRI. Most of the time women don't know they have fat necrosis, it's something imagers see.

    Ultrasound is very helpful in the acute setting (in conjunction with mammo) and there are telltale things that support the suspicion of fat necrosis. Fat necrosis from minor trauma typically resovles in a few months. Sometimes, radiologists may assign BiRads-3 for fat necrosis if it's an unusual situation (i.e. Male breast, no definite inciting trauma, etc)- ensure it resolves or "evolves appropriately" over time. By 3 months it should be gone or have evolved into "classic slam-dunk appearing" fat necrosis.

    On mammo it is most commonly seen as oil cysts and coarse calcifications. These calcifications 99% of the time LOOK like fat necrosis (maybe not to the untrained eye). The appearance evolves for years due to fibrosis (scarring). After a few years, we dont expect coarse calcifications to further coarsen- there is a plateau afterwhich the fat necrosis changes we see are stable for 10, 15, 20+ years. If there is a change... particularly if the chaging fat necrosis is at site of lumpectomy- it raises suspicion for recurrence and will need to be biopsied. Fat necrosis does not show up far remotely from the time of trauma (i.e. fat necrosis many years after site of excisional biopsy)- however it may take up to 1.5 yrs after trauma until it is FELT by man or woman. (that's how long it takes for that palpable scarred fibrotic calcified lump to form fully). But remember, fat necrosis can be seen on imaging at all stages- it is not necessary to be palpable, radiologists can still see whats happening in the breast even if you cant feel it!

  • beesie.is.out-of-office
    beesie.is.out-of-office Member Posts: 1,435
    edited December 2020

    peggysmom, thank you for the information. That's good to know. I guess the fat necrosis that I had must have developed from some minor trauma that never even registered with me, and by coincidence just happened to be in the same location as my earlier excisional biopsy.

  • reader425
    reader425 Member Posts: 820
    edited December 2020

    My lumpectomy site was followed for 2-3 years, every six months via mammogram with a description of "likely developing fat necrosis ". Finally it was noted as B-9 and am now on yearly mammogram schedule. Glad they were careful but also glad things have settled!

  • Riverajoe3
    Riverajoe3 Member Posts: 3
    edited December 2020

    I just left the drs today with a mammogram. They also did a ultrasound and still didnt know what it is. They said its not fat necrosis. Which I still second guessing. Idk. He did say no signs of cancer that obvious, so that's good news, but he wants to do a mri now. So waiting to get that done. Just wanted to give a update. Thank you all for your replies.

  • beesie.is.out-of-office
    beesie.is.out-of-office Member Posts: 1,435
    edited December 2020

    Riverajoe, thanks for the update, and sorry that you don't have answers and require more testing. Get yourself a copy of today's mammogram and ultrasound report; maybe the written report will provide some insight into what the radiologist thinks this might be.

    Good luck with the MRI. Please let us know what happens.

  • reader425
    reader425 Member Posts: 820
    edited December 2020

    Riverajoe, glad there's nothing obviously bad but also sorry things are not clear. Keep us posted. Thinking of you. Waiting is hard. 🙏

  • ashlyn525
    ashlyn525 Member Posts: 13
    edited December 2020

    I'll start out saying I have severe anxiety. I have a hard area that formed in breast where surgery and radiation were. I had a lumpectomy end of April. Breast reduction End of May with delayed healing then finished radiation October 20th. My Oncatype was 4 They did mammogram and ultrasound and said most likely fat necrosis but to ease anxiety do a biopsy. Biopsy next week. Am I reading right that they would know 100% of it were fat necrosis from ultrasound? Has anyone ever heard of this ? I have been terrified.

  • ashlyn525
    ashlyn525 Member Posts: 13
    edited December 2020

    I had a lumpectomy at the end of April and sentinel lymph node surgery with clear margins . Then had breast reduction/reconstruction on both breast May 26th with all tissue clear. I had delayed healing from reduction. I finished Radiation October 20. There was a hard place towards top outer of right breast. I kept telling everyone. Finally they said I could have a mammogram. They said because of my anxiety we could biopsy but thought it was fat necrosis. Am I understanding right that they would have known for sure if it was fat necrosis? Just very scary

  • beesie.is.out-of-office
    beesie.is.out-of-office Member Posts: 1,435
    edited December 2020

    "Am I understanding right that they would have known for sure if it was fat necrosis?"

    Unfortunately that answer does not appear to be clear. According to peggysmom, who is a breast radiologist, fat necrosis in most cases "appears very classic on imaging. Nonetheless, you can evaluate this newly palpable lump with mammography which can easily confirm if what you are feeling is indeed fat necrosis." That said, I was sent for a biopsy for what turned out to be fat necrosis, as were many other people who've come through this site, precisely because it was not clear enough on imaging that what we had was fat necrosis.

    In your case, if from the appearance on imaging the radiologist believes that what you have is fat necrosis, then it would appear that short-term follow-up imaging would be a reasonable approach instead of having a biopsy now. As peggysmom said, "By 3 months it should be gone or have evolved into "classic slam-dunk appearing" fat necrosis."

    What was suggested as follow-up if you opt to not have the biopsy?

  • ashlyn525
    ashlyn525 Member Posts: 13
    edited December 2020

    Thank you Bessie!!! I’m having a biopsy next week. The doctor said he felt it was the only way I would have peace of mind. I never had a lump before. It was found as calcifications on routine mammogram. They told me I could wait 6 months and thankfully I chose not to. I was feeling pretty positive until I read the slam dunk comment. This site has been so helpful to me. I had routine mammogram the week before they stopped them for Covid. This site has been my only way to see what other people have dealt with. All support groups have stopped in my area. Fortunately I don’t know many people with breast cancer.

  • ashlyn525
    ashlyn525 Member Posts: 13
    edited December 2020

    Hi Bessie. We didn't discuss other options. He said most patients he would follow up with in 6 months or at annual mammogram. He felt I couldn't handle that. I guess I have to trust what he says. The waiting is a nigh

  • ashlyn525
    ashlyn525 Member Posts: 13
    edited December 2020

    Hi! I just received biopsy results and it was fat necrosis! Yay! Maybe they knew but the biopsy sure made me feel better!

  • beesie.is.out-of-office
    beesie.is.out-of-office Member Posts: 1,435
    edited December 2020

    Great news, Ashlyn! Thanks for letting us know.


  • amanda6
    amanda6 Member Posts: 50
    edited December 2020

    just saw this thread & thought I'd add my fat necrosis experience for anyone who comes looking down the line. I was diagnosed with it 10 years ago just after my treatment - had at that point finished rad, chemo, surgery. It presented as a red patch on the skin and a lump. Had an mri ( or cat scan, not sure which), & it was diagnosed as fat necrosis. Over the years I got used to it being there & the feel of it was consistent. A few weeks ago it began to feel different to me & I had it checked - it felt more pronounced & rounded than usual. Doc was not too concerned but for peace of mind sent me for a diagnostic mammo. Turned out ok, all felt the reason it seemed different to me is because I had recently lost 7 lbs, so some fatty tissue covering it was no longer there. The redness on my breast has faded somewhat but is still there btw. So just to say that as we gain/ lose weight, the feel & appearance of our breasts can change too.

    So glad it turned out well for you Ashlyn:)

  • ashlyn525
    ashlyn525 Member Posts: 13
    edited December 2020

    Thanks for sharing! So awesome to see you doing well!

  • ashlyn525
    ashlyn525 Member Posts: 13
    edited December 2020

    Sorry Beesie I spelled your name wrong.

  • Beclyn20
    Beclyn20 Member Posts: 18
    edited January 2021

    Great news Ashlyn!

    Amanda, I think that just recently happened to me. I am 2 years out and mine got red, painful and changed. I too have lost weight and think that made a difference. It is getting better but it is a hard lump which I will have to live with. I have not had it looked at yet but common sense said it is not the original cancer because that was slow growing. Thanks for sharing! Congrats on your 10 years~! Happy New Year!

  • ctmbsikia
    ctmbsikia Member Posts: 749
    edited January 2021

    Morning. I'm bumping this up again to ask you fine ladies who have lived with fat necrosis did you have short interval imagining? Did you ever get a normal score on a mammogram or MRI?

    I just had an MRI and got another birads 3. Mammo from last Sept was also a birads 3. I did receive a call from my BS which I am grateful for. I will see her in April after my follow up mammo. I maybe an odd one here as we are going to discuss an excision of this pesky thing. Were any of you offered surgery as a treatment option? I don't really want all these tests coming back see you in 6 months. Over the last year I am experiencing some contracture at this spot, but no redness. No real pain, just tenderness is the best word I can think of to describe it.