Breast fat necrosis is a focal aseptic necrosis of the fatty tissue of the breast with its subsequent replacement by scar tissue. Fat necrosis is characterized by the appearance of a dense painful formation deforming the mammary gland; skin retraction and a change in its color, which first of all makes you think about tumor processes. Diagnosis includes palpation of the breast, ultrasound, mammography, fine needle biopsy. Treatment of fat necrosis requires performing a sectoral resection of the breast.
ICD 10
N64.1 Breast fat necrosis
Meaning
Breast fat necrosis (oleogranuloma, lipogranuloma, steatogranuloma) refers to non-enzymatic necrosis, most often caused by various breast injuries. According to clinical observations carried out by modern mammology, fat necrosis accounts for 0.6% of cases of all nodular formations of the mammary glands. Fatty necrosis of the mammary glands is more common in patients with macromastia than in women with small breasts.
Traumatic factors can be accidental bruises and blows in everyday life or transport, medical manipulations, sports training. Less often, the cause of breast fat necrosis is rapid weight loss or radiation therapy. In some cases, the formation of fatty necrosis is noted in patients who underwent reconstructive mammoplasty with their own tissues after mastectomy.
Damage to the capillaries can lead to loss of blood supply to the local area of adipose tissue. Further changes are characterized by the development of reactive inflammation in the damaged area with the formation of a demarcation zone delimiting the dead tissue. After the inflammation subsides, the process of fibrosis begins – the replacement of necrotic masses with connective tissue cells. In these cases, scar tissue forms at the site of necrosis. In the future, calcium salts may be deposited on the site of breast fat necrosis, causing calcification (petrification) of the focus of necrosis; in some cases, ossification processes are noted.
Symptoms
The development of fat necrosis in most cases is preceded by a traumatic effect on the mammary gland. At the site of the injury, a painful tumor appears, soldered to the skin, having a rounded shape and dense consistency. In the future, the area of breast fat necrosis may lose sensitivity.
The skin above the breast tumor may have a cyanotic or red color. With the formation of breast fat necrosis in the area of the areola, the nipple may be retracted. Unlike mastitis, with breast fat necrosis, body temperature, as a rule, remains normal.
Dense infiltration, breast deformity, the appearance of “dimples” on the skin, an increase in lymph nodes gives fatty necrosis an external similarity with the clinical picture of breast cancer. In unfavorable cases, the development of breast fat necrosis may occur with septic melting of the focus and sequestration.
Diagnostics
When diagnosing breast fat necrosis, it is important to indicate to the patient a recent breast injury. In the process of palpation of the mammary gland, the mammologist easily determines a painful seal with indistinct contours, sometimes – fluctuation. Ultrasound of the breast does not reveal the characteristic distinctive signs of fat necrosis.
Conducting an overview mammography, CT or MRI of the mammary glands reveals a nodular formation with an inhomogeneous structure, heavy uneven contours. The X-ray, tomographic and echographic picture of fatty necrosis often resembles that of breast cancer. Later, when calcification occurs, the focus of fatty necrosis of the mammary gland looks on mammograms in the form of spherical calcinate of the “eggshell” type, which makes it possible to exclude the malignancy of the process.
For differential diagnosis, a breast biopsy (puncture fine needle or trepanobiopsy) is indicated, followed by cytological and histological examination of the samples obtained. Breast biopsy is recommended to be performed under ultrasound or X-ray control.
Treatment and prevention
Taking into account irreversible focal changes in adipose tissue, as well as the difficulties of differential diagnosis with adipose necrosis, organ-preserving sectoral resection is indicated – removal of a part (sector) of the breast.
Only postoperative histological examination of the macropreparation makes it possible to exclude the oncological process. Microscopically, breast fat necrosis is represented by nodular growths of granulation tissue from epithelioid cells, multinucleated giant lipophages and xanthoma cells around fat inclusions. One of the components of lipogranulomas are fatty cysts – thin-walled cavities filled with oily and serous fluid.
To prevent fat necrosis, it is necessary to avoid injuries to the mammary glands, as well as to contact a mammologist in a timely manner if damage has occurred. In case of injury to the breast, it is necessary to give it an elevated position with a bandage.