Fat necrosis in the breast is a benign condition resulting from damage to fatty breast tissue. It commonly presents as a lump and frequently resolves on its own.
Understanding Fat Necrosis
Fat necrosis occurs when fatty breast tissue is injured. The body’s natural response involves an inflammatory process where dead fat cells release their oily contents. This can lead to a firm, scar-like lump, or sometimes an “oil cyst” if oily fluid collects in a sac.
Common causes include minor or significant trauma to the breast. It frequently develops after breast surgeries like lumpectomy, breast reduction, breast reconstruction, or biopsies. Radiation therapy can also contribute. Fat necrosis can appear months or even years after the initial injury or procedure.
Identifying Fat Necrosis
Individuals with fat necrosis may notice a firm lump in the breast. The lump is often painless but can be tender or cause discomfort. Other possible signs include thickened, reddened, or bruised skin around the lump, or even skin dimpling and nipple retraction. These symptoms can sometimes resemble those of cancerous masses, making medical evaluation important.
The diagnostic process begins with a physical examination. Imaging techniques like mammography and ultrasound differentiate fat necrosis from other conditions. Mammography shows the mass and calcifications; ultrasound helps determine if the lump is solid or cystic. MRI may also be used for a more detailed view, especially if other imaging is inconclusive. If there is any doubt, a biopsy (fine needle aspiration or core needle biopsy) is performed to examine tissue samples and confirm the benign diagnosis.
Treatment Strategies
In many instances, fat necrosis does not require specific treatment and may resolve naturally over weeks or months. This is often the case when the area is small and not causing bothersome symptoms. Observation with regular follow-up appointments can be a sufficient approach.
For individuals experiencing tenderness or pain, conservative management strategies provide relief. Over-the-counter pain relievers, like ibuprofen, may help reduce discomfort and inflammation. Applying warm compresses or gentle massage can also alleviate symptoms. If an oil cyst forms and is large or causing significant discomfort, a healthcare provider might drain the fluid using a fine needle aspiration to flatten the lump.
Surgical intervention is considered when the lump is large, persistent, causes significant discomfort or cosmetic concerns, or if diagnostic uncertainty remains after imaging and biopsy. Surgery aims to confirm diagnosis or relieve symptoms, not because the condition is dangerous. Surgical options include:
Excisional biopsy: Surgically removing the damaged tissue, which can be done under local or general anesthesia and may result in a small scar.
Vacuum-assisted excision biopsy: A small cut is made, and breast tissue is suctioned out using a specialized device.
Liposuction: Used to remove the area of fat necrosis, potentially resulting in less tissue indentation.
Long-Term Considerations
Fat necrosis is a benign condition and does not increase breast cancer risk. This reassures individuals concerned about a breast lump. While many fat necrosis lumps may shrink or disappear completely over time, some might persist as a firm area or develop calcifications.
Continued regular breast screenings and follow-up appointments remain important. This ensures monitoring of existing fat necrosis and prompt evaluation of new breast changes. Maintaining open communication with healthcare professionals about breast health concerns is advisable.