About Fat Necrosis of the Breast

Fat necrosis is a benign condition that can occur in your breast.  It consists of fatty tissue that has been bruised, injured, or has died. Fat necrosis can result after any type of breast surgery, from biopsy to reconstruction.  Once fatty tissue has been injured or has died, it can gradually change into scar tissue or may collect as liquid within an oil cyst. Fat necrosis does not lead to the development of breast cancer, but it may sometimes cause breast pain.
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Symptoms of Breast Fat Necrosis
An area of fat necrosis in your breast may feel like a fairly hard lump, or like a section of thick skin. Your breast may feel tender or painful in the tissue near the fat necrosis. You may see some drainage from the nipple that is nearest the bruised region. Sometimes, your nipple may pull inward a little bit, or your breast skin may dimple above the lump of fat necrosis. If you have an oil cyst, it may feel like a smooth and squishy lump.
Causes of Breast Fat Necrosis

Fatty tissue in your breast may break down or die after any type of traumatic breast injury or surgery. A breast biopsy, whether it is a needle biopsy or a surgical biopsy  can also cause breast fat necrosis. Fat necrosis may also form around substances that have been injected into your breast, such as silicone or paraffin. Breast radiation treatment may sometimes cause an area of fat necrosis.

Fat Necrosis Imitates Other Breast Lumps
One reason that fat necrosis can be difficult to diagnose is that it resembles several other breast lumps. Masses made of breast fat necrosis may look like malignant breast tumors on mammograms and other imaging studies. The mass may look dense, have an irregular shape, a spiky border, and a collection of microcalcifications. Fat necrosis in the breast may appear to be atypical lipoma or liposarcoma, both very rarely found in breast tissue. If the fat has turned into liquid, it can look like a cyst on an ultrasound. Breast fat necrosis can take on different appearances over time, so follow-up mammograms will show a change in the mass.

How Breast Fat Necrosis Is Diagnosed
Fat necrosis often looks and feels like many other breast lumps. If you think you have an area of fat necrosis in your breast, see your family doctor or gynecologist for a clinical breast exam. You will need to have a list of breast surgeries and recent health conditions to show your doctor. Expect to be sent for a mammogram, which may reveal a dense, malignant mass with spiculated (spiky) edges and an irregular shape. It's very likely that a breast ultrasound will come next -- as this helps find oil cysts. If neither one of these images are conclusive, a breast MRI may be ordered. The final diagnosis may require a biopsy to confirm fat necrosis, because a microscopic examination of the cells will shed the most light on your condition
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Treatment For Fat Necrosis Of The Breast
Each case of fat necrosis is unique, so treatments will vary. If your fat necrosis has occurred recently, using warm compresses may help it subside. When fat necrosis causes
pain, you can use ibuprofen and aspirin, but if that doesn't help, ask your doctor if a prescription medication may be used.

In cases where a lump of fat necrosis is large and causing discomfort or distress, it may be removed with a vacuum-assisted core needle or a lumpectomy. An oil cyst can be drained with a fine needle, or it can be surgically removed.

If you have recently had a breast injury or surgery and you suspect fat necrosis, try warm compresses and gentle massage -- because with care, sometimes the tissues will heal and the necrosis will resolve on its own.
Sourced From: Fat necrosis of the breast. Meyer JE, Silverman P, Gandbhir L. Arch Surg. 1978 Jul;113(7):801-5.