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Rijkx MEP, Heuts EM, Houwers JB, Hommes JE, Piatkowski AA, van Nijnatten TJA. Imaging findings after a total reconstructed breast with autologous fat transfer: what the radiologist needs to know. BJR Open 2024; 6:tzae010. [PMID: 38798692 PMCID: PMC11128096 DOI: 10.1093/bjro/tzae010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 03/09/2024] [Accepted: 04/13/2024] [Indexed: 05/29/2024] Open
Abstract
Autologous fat transfer (AFT) is an upcoming technique for total breast reconstruction. Consequently, radiological imaging of women with an AFT reconstructed breast will increase in the coming years, yet radiological experience and evidence after AFT is limited. The surgical procedure of AFT and follow-up with imaging modalities including mammography (MG), ultrasound (US), and MRI in patients with a total breast reconstruction with AFT are summarized to illustrate the radiological normal and suspicious findings for malignancy. Imaging after a total breast reconstruction with AFT appears to be based mostly on benign imaging findings with an overall low biopsy rate. As higher volumes are injected in this technique, the risk for the onset of fat necrosis increases. Imaging findings most often are related to fat necrosis after AFT. On MG, fat necrosis can mostly be seen as oil cysts. The occurrence of a breast seroma after total breast reconstruction with AFT is an unfavourable outcome and may require special treatment. Fat deposition in the pectoral muscle is a previously unknown, but benign entity. Although fat necrosis is a benign entity, it can mimic breast cancer (recurrence). In symptomatic women after total breast reconstruction with AFT, MG and US can be considered as first diagnostic modalities. Breast MRI can be used as a problem-solving tool during later stage. Future studies should investigate the most optimal follow-up strategy, including different imaging modalities, in patients treated with AFT for total breast reconstruction.
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Affiliation(s)
- Maud E P Rijkx
- Department of Plastic, Reconstructive, and Hand Surgery, Maastricht University Medical Center+, 6202 AZ, Maastricht, The Netherlands
- NUTRIM School for Nutrition, and Translational Research in Metabolism, Maastricht University, 6229 ER, Maastricht, The Netherlands
| | - Esther M Heuts
- Department of Surgery, Maastricht University Medical Center+, 6202 AZ, Maastricht, The Netherlands
- GROW Research Institute for Oncology and Reproduction, Maastricht University, 6229 ER, Maastricht, The Netherlands
| | - Janneke B Houwers
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, 6202 AZ, Maastricht, The Netherlands
| | - Juliette E Hommes
- Department of Plastic, Reconstructive, and Hand Surgery, Maastricht University Medical Center+, 6202 AZ, Maastricht, The Netherlands
- NUTRIM School for Nutrition, and Translational Research in Metabolism, Maastricht University, 6229 ER, Maastricht, The Netherlands
| | - Andrzej A Piatkowski
- Department of Plastic, Reconstructive, and Hand Surgery, Maastricht University Medical Center+, 6202 AZ, Maastricht, The Netherlands
- NUTRIM School for Nutrition, and Translational Research in Metabolism, Maastricht University, 6229 ER, Maastricht, The Netherlands
| | - Thiemo J A van Nijnatten
- GROW Research Institute for Oncology and Reproduction, Maastricht University, 6229 ER, Maastricht, The Netherlands
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, 6202 AZ, Maastricht, The Netherlands
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Lagumdzija J, Wechselberger G. Unknown Case: Linear Distribution of Calcifications in a Patient Presenting for Elective Aesthetic Surgery. JOURNAL OF BREAST IMAGING 2023; 5:744-745. [PMID: 38141241 DOI: 10.1093/jbi/wbad056] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Indexed: 12/25/2023]
Affiliation(s)
- Jasmina Lagumdzija
- Hospital of the Brothers of St. John of God, Department of Plastic, Reconstructive, and Aesthetic Surgery, Salzburg, Austria
| | - Gottfried Wechselberger
- Hospital of the Brothers of St. John of God, Department of Plastic, Reconstructive, and Aesthetic Surgery, Salzburg, Austria
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Winkler NS, Tran A, Kwok AC, Freer PE, Fajardo LL. Autologous Fat Grafting to the Breast: An Educational Review. JOURNAL OF BREAST IMAGING 2022; 4:209-221. [PMID: 38422423 DOI: 10.1093/jbi/wbab055] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Indexed: 03/02/2024]
Abstract
Autologous fat grafting (AFG) is a technique that is increasingly utilized in breast cosmetic and reconstructive surgery. In this procedure, fat is aspirated by liposuction from one area of the body and injected into the breast. The procedure and process of AFG has evolved over the last few decades, leading to more widespread use, though there is no standard method. Autologous fat grafting is generally considered a safe procedure but may result in higher utilization of diagnostic imaging due to development of palpable lumps related to fat necrosis. Imaging findings depend on surgical technique but typically include bilateral, symmetric, retromammary oil cysts and scattered dystrophic and/or coarse calcifications when AFG is used for primary breast augmentation. More focal findings occur when AFG is used to improve specific areas of cosmetic deformity, scarring, or pain following breast cancer surgery. As with any cause of fat necrosis, imaging features tend to appear more benign over time, with development of rim calcifications associated with oil cysts and a shift in echogenicity of oil cyst contents on ultrasound towards anechoic in some cases. This article reviews the AFG procedure, uses, complications, and imaging findings.
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Affiliation(s)
- Nicole S Winkler
- University of Utah and Huntsman Cancer Institute, Department of Radiology and Imaging Sciences, Salt Lake City, UT, USA
| | - Alexander Tran
- University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Alvin C Kwok
- University of Utah and Huntsman Cancer Institute, Department of Plastic Surgery, Salt Lake City, UT, USA
| | - Phoebe E Freer
- University of Utah and Huntsman Cancer Institute, Department of Radiology and Imaging Sciences, Salt Lake City, UT, USA
| | - Laurie L Fajardo
- University of Utah and Huntsman Cancer Institute, Department of Radiology and Imaging Sciences, Salt Lake City, UT, USA
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Akyol M, Kayali A, Yildirim N. Traumatic fat necrosis of male breast. Clin Imaging 2013; 37:954-6. [PMID: 23849832 DOI: 10.1016/j.clinimag.2013.05.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Revised: 04/19/2013] [Accepted: 05/31/2013] [Indexed: 11/26/2022]
Abstract
Fat necrosis is a benign nonsuppurative inflammatory process that most commonly occurs in female breast. It is a rare condition in male breast. There are very few reports in the literature. There is a wide range of manifestations of fat necrosis and can mimic breast cancer clinically and radiologically. We report a case of fat necrosis of the breast in a 57-year-old man.
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Affiliation(s)
- Muammer Akyol
- Radiology Department, Elazig Training and Research Hospital, Rizaiye Mah, Hastane Sk. 23100, Elazig, Turkey.
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Affiliation(s)
- Gary J Whitman
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX 77230-1439, USA.
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Abstract
Benign breast diseases constitute a heterogeneous group of lesions arising in the mammary epithelium or in other mammary tissues, and they may also be linked to vascular, inflammatory or traumatic pathologies. Most lesions found in women consulting a physician are benign. Ultrasound (US) diagnostic criteria indicating a benign lesion are described as well as US findings in the most frequent benign breast lesions.
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Affiliation(s)
- N. Masciadri
- IRCCS Multimedica, Sesto S. Giovanni, Milan, Italy
| | - C. Ferranti
- Fondazione IRCCS Istituto Nazionale Tumori, Unit of Diagnostic Radiology 3, Senology, Milan, Italy
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7
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Chan C, McCulley S, Macmillan R. Autologous fat transfer – a review of the literature with a focus on breast cancer surgery. J Plast Reconstr Aesthet Surg 2008; 61:1438-48. [DOI: 10.1016/j.bjps.2008.08.006] [Citation(s) in RCA: 132] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2008] [Accepted: 08/21/2008] [Indexed: 02/06/2023]
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Abstract
Ultrasound use should be considered in most instances of a palpable breast finding, particularly in young women. A primary advantage is the ability to directly correlate the physical exam finding with imaging. Ultrasound is useful in characterizing palpable masses as well as detecting cancer in women with negative mammograms. The negative-predictive value of imaging for cancer in the evaluation of a palpable lump is very high, which may reassure women with low-suspicion palpable findings. Short-term follow-up of a palpable mass with benign features may be feasible, though further study is needed to establish criteria. A suspicious dominant palpable finding should be further evaluated even if imaging is negative.
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Tan PH, Lai LM, Carrington EV, Opaluwa AS, Ravikumar KH, Chetty N, Kaplan V, Kelley CJ, Babu ED. Fat necrosis of the breast—A review. Breast 2006; 15:313-8. [PMID: 16198567 DOI: 10.1016/j.breast.2005.07.003] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2005] [Accepted: 07/20/2005] [Indexed: 12/01/2022] Open
Abstract
Fat necrosis of the breast is a benign condition that most frequently affects peri-menopausal women. It can mimic breast cancer clinically or radiologically. In other cases it can obscure malignant lesions. The core of this review is derived from a MEDLINE database literature search from 1966-2004. Further references were from lateral search. In this paper, we review the pathogenesis and pathology clinical and radiological features of fat necrosis of the breast. The implication of fat necrosis in the management of patients with breast lump is also discussed. Fat necrosis of breast is a complex process. Therefore, a systematic review of this condition will enable surgeons, radiologists and oncologists working in the field of breast disease to understand it better and improve its management.
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Affiliation(s)
- P H Tan
- Department of Surgery, Hillingdon Hospital NHS Trust, Pield Health Road, Uxbridge, Middlesex, UB8 3NN, UK
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Crystal P, Bukhanov K. Sonographic findings of palpable isoechoic breast fat necrosis: look for skin integrity. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2005; 24:105-107. [PMID: 15615935 DOI: 10.7863/jum.2005.24.1.105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Affiliation(s)
- Pavel Crystal
- Department of Medical Imaging, Mount Sinai Hospital, 600 University Ave, Toronto, ON M5G 1X5, Canada.
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Baillie M, Mok PM. Fat necrosis in the breast: Review of the mammographic and ultrasound features, and a strategy for management. ACTA ACUST UNITED AC 2004; 48:288-95. [PMID: 15344975 DOI: 10.1111/j.0004-8461.2004.01309.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The present study reviews the mammographic and ultrasound features of fat necrosis, the degree of correlation between the two modalities, and proposes a strategy for management, especially in cases with atypical appearances.
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Affiliation(s)
- M Baillie
- Department of Radiology, North Shore Hospital, PB 93-503, Takapuna, Auckland 9, New Zealand.
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Chala LF, de Barros N, de Camargo Moraes P, Endo E, Kim SJ, Pincerato KM, Carvalho FM, Cerri GG. Fat necrosis of the breast: mammographic, sonographic, computed tomography, and magnetic resonance imaging findings. Curr Probl Diagn Radiol 2004; 33:106-26. [PMID: 15215818 DOI: 10.1067/j.cpradiol.2004.01.001] [Citation(s) in RCA: 98] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Fat necrosis of the breast is a benign inflammatory process that may be mistaken for cancer in clinical examination or imaging studies. Although its mammographic manifestations are well known, data from other imaging modes, particularly sonography and magnetic resonance imaging, are limited. With the growing number of breast surgeries performed today (eg, breast-conserving, autologous tissue reconstruction, mammoplasty), fat necrosis is seen more often in daily practice. Knowledge of its imaging features could improve clinical management, including the avoidance of unnecessary biopsy procedures. The main objectives of this article are to review the literature and to relate the manifestations of fat necrosis on mammography, sonography, magnetic resonance imaging, and computed tomography to their associated histopathologic events.
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Affiliation(s)
- Luciano Fernandes Chala
- Instituto de Radiologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (INRAD-HCFMUSP), São Paulo, Brazil.
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Bilgen IG, Ustun EE, Memis A. Fat necrosis of the breast: clinical, mammographic and sonographic features. Eur J Radiol 2001; 39:92-9. [PMID: 11522417 DOI: 10.1016/s0720-048x(00)00303-x] [Citation(s) in RCA: 101] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE the purpose of this study was to describe and quantitate the clinical, mammographic and sonographic (US) features and to evaluate the evolution of fat necrosis in the breast. MATERIALS AND METHODS a retrospective review of the clinical, mammographic and US findings of 126 fat necrosis lesions in 94 patients, diagnosed between 1989 and 1999, was done. All the cases included in the study had at least 3 years follow-up mammograms. In addition, 48 patients with a total of 62 fat necrosis lesions, also had an US follow-up. Fat necrosis was diagnosed on the basis of histologic (n=25) and initial or follow-up imaging (n=69) findings. RESULTS the predominant mammographic features of the 114 lesions apparent on mammograms were radiolucent oil cyst (n=34, 26.9%), round opacity (n=16, 12.6%), asymmetrical opacity or heterogenicity of the subcutaneous tissues (n=20, 15.8%), dystrophic calcifications (n=34, 26.9%), clustered pleomorphic microcalcifications (n=5, 3.9%), and suspicious speculated mass (n=5, 3.9%). In five patients with 12 (9.5%) palpable masses, mammograms were normal. The predominant US features of the 112 lesions apparent on sonograms were solid (n=18, 14.2%), anechoic with posterior acoustic enhancement (n=21, 16.6%), anechoic with posterior acoustic shadowing (n=20, 15.8%), cystic with internal echoes (n=14, 11.1%), cystic with mural nodule (n=5, 3.9%) and increased echogenicity of the subcutaneous tissues (n=34, 26.9%). In five patients with 14 (11.1%) lesions, sonographic examination was normal. Mammographic follow-up showed that five of the radiolucent oil cysts developed curvilinear calcifications, six of the round opacities decreased in size and density, and another two disappeared. Eleven of the dystrophic calcifications became even more coarse. Six of the asymmetrical opacities became vague and one developed an oil cyst and coarse calcifications. The only nonoperated speculated mass developed a typical small radiolucent oil cyst in the centre. US follow-up showed that 18 of the 29 increased subcutaneous tissue echogenicity turned back to normal, while in the remaining 11 small cysts formed. In 19 solid appearing masses, 15 showed decrease in size, while four remained stable (biopsy disclosed fat necrosis). The four complex masses in two patients showed increase in size and appeared more cystic (FNAB was consistent with fat necrosis). CONCLUSION a spectrum of imaging findings is associated with fat necrosis. Knowledge of the mammographic and US appearance and evolution of these patterns may enable imaging follow-up of these lesions, reducing the number of unnecessary biopsies.
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Affiliation(s)
- I G Bilgen
- Ege University Hospital, Department of Radiology, Bornova, 35100 Izmir, Turkey
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Abstract
Ultrasound is second in importance only to mammography in the evaluation of breast abnormalities. The ability of US to diagnose benign simple cysts accurately has spared innumerable women from needless biopsies and aspirations. When a suspicious solid abnormality is detected by ultrasound, it readily provides convenient, inexpensive, accurate imaging guidance for interventional procedures. Future studies of US as a screening tool must weigh potential benefits against the potential risks because of increased biopsies performed for false-positive results.
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Affiliation(s)
- D N Smith
- Harvard Medical School, Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA
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