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Breast fat necrosis is a condition characterized by the presence of benign masses in the breast. Fat necrosis can develop anywhere inside the breast, but does not increase the chances of developing breast cancer. Usually, patients themselves discover the lumps or they might show up during a routine mammogram.

Causes of Breast Fat Necrosis

Fat necrosis most commonly occurs as a side effect of breast surgery. It can also be caused by trauma to the breast like any injury or as a result of radiation therapy or even a needle biopsy. On discovering fat necrosis lumps, women often panic thinking it is breast cancer. However, fat necrosis is harmless and does not develop into or increase the risk of development of breast cancer in the future. It is a result of lack of oxygen supply to the fat cells and not a sign of carcinoma.

Breasts have glands and ducts that produce and carry milk to the nipple. These ducts are surrounded by fibrous fat tissue. When the fat cells are deprived of oxygenated blood, the cells die causing ‘necrosis‘ or cell decay.  Cell death triggers the release of chemicals that help clear off the dead cells with the help of some enzymes. These enzymes break down fat into smaller fragments that can be readily absorbed into the bloodstream. This enzymatic action results in calcium deposits that are seen in breast fat necrosis.

Symptoms of Breast Fat Necrosis

Common symptoms experienced by women who have breast fat necrosis are:

• The presence of firm, round-shaped lumps in the breast
• The lumps are mostly painless, but can be tender and painful in some women
• The skin surrounding the mass looks red in color and can be bruised
• Discharge of fluid from the nipple
• Inversion or retraction of the nipple

However, some women with breast fat necrosis don’t experience any of these symptoms at all.

Diagnosis of Breast Fat Necrosis

X-ray images of breast fat necrosis show a thin outer ring with an irregular outline, which is the outer edge of the dead cell build up. In most cases, the clear ‘fat density‘ inside the ring differentiates the condition from cancer as these cells do not absorb light, while cancer cells do. Fat necrosis masses are usually smaller in size with a diameter of nearly 2 cm when compared to the size of cancer cells. However, in some cases the features of the fat necrosis on X-ray looks very similar to that of cancer cells and becomes a concern, though it is a fully benign condition.

Once a lump is found in the breast, the patient is sent to a breast clinic for further tests which include:

• A thorough breast examination
• A mammogram or sonogram
• Fine needle aspiration or core biopsy

If fat necrosis is clear from the ultrasound or mammogram, the biopsy can be avoided. If the biopsy is also inconclusive, a small operation called excision biopsy may be needed to confirm fat necrosis.

Treatment of Fat Necrosis

Fat necrosis usually does not necessitate any treatment or follow-up. If the necrosis contains oily fluid it needs to be aspirated using a needle to relieve discomfort to the patient. Mostly, a fat necrosis mass goes away without any intervention. If it does not, a minor surgery may be needed to remove it. Fat necrosis that results from a breast surgery or radiotherapy usually causes mild discomfort and pain which can be treated with anti-inflammatory medications such as ibuprofen.

Although breast fat necrosis does not increase the chances of development of breast cancer, it is important for patients to be aware and consult their doctor in case of any breast changes in the future.

References

• https://www.breastcancercare.org.uk/information-support/have-i-got-breast-cancer/benign-breast-conditions/fat-necrosis
• http://breast-cancer.ca/necrofat/
• http://www.cancer.org/healthy/findcancerearly/womenshealth/non-cancerousbreastconditions/non-cancerous-breast-conditions-fat-necrosis-oil-cysts
• http://www.ajronline.org/doi/full/10.2214/AJR.08.1250

Further Reading

• All Necrosis Content
• Why Does Coumadin Necrosis Occur?

Written by

Susha Cheriyedath

Susha has a Bachelor of Science (B.Sc.) degree in Chemistry and Master of Science (M.Sc) degree in Biochemistry from the University of Calicut, India. She always had a keen interest in medical and health science. As part of her masters degree, she specialized in Biochemistry, with an emphasis on Microbiology, Physiology, Biotechnology, and Nutrition. In her spare time, she loves to cook up a storm in the kitchen with her super-messy baking experiments.