Fat Necrosis

Fat necrosis is a rare lesion of the breast but is of clinical importance because it produces a mass, often accompanied by skin or nipple retraction, that is indistinguishable from carcinoma. Trauma is presumed to be the cause, though only about 50% of patients give a history of injury. Ecchymosis is occasionally present. If untreated, the mass effect gradually disappears.

Fat necrosis is a benign  breast condition whereby a firm lump forms in an area of fatty breast tissue that has been damaged. The nodules and plaques appear in the first several weeks of life. brownish color. This may be due to fat necrosis. The blood supply to fat is always poor and many events around the time of surgery can interfere with this. related objective is to establish MR imaging criteria that can be used reliably to differentiate this entity from other more serious causes of soft-tissue masses. This problem is most often seen in obese women who have very large breasts or after an injury to a breast. A granulomatous infiltrate forms subsequently and nonrenal absorption of calcium increases. These drain to the surface. The remaining tissue may become hard or calcified. Fat necrosis can be caused by an injury or blow to the breast. Sometimes the skin around this lump looks red or bruised In small areas the treatment is to keep the area clean and express any liquid fat that may develop.Fat necrosis is sometimes seen following a motor vehicle accident in which the seat belt has forcefully squeezed the breast The lump is usually painless, and the skin around it may look red, bruised or dimpled.

Sometimes the normal fat cells in the breast become round, firm lumps made up of damaged fatty tissue It is postulated that cold or stress-induced injury to immature fat results in the development of solidification and necrosis This may be from previous surgery to the breast or a bruise or injury to the breast. For example a patient may have excessive swelling, pressure or congestion in then surgical area. Fat necrosis after trauma is a common cause of palpable lumps in children and has a benign course on long-term follow-up. If the area is large the process can be speeded up by surgical exploration. The lump is usually painless, and the skin around it may look red, bruised or dimpled. Breast lumps are either benign (noncancerous) or malignant

Causes of Fat Necrosis

The common causes of Fat Necrosis :-

• An underlying defect in fat composition or metabolism may be present, whereby inadequately developed enzyme systems involved in fatty acid desaturation result in increased saturated fatty acids within the subcutaneous tissue.
• Local pressure trauma during delivery from macrosomia, forceps, or prolonged trauma may play a role in the induction of necrosis.
• Other causes of poor blood circulation to the bone include a blockage by air or fat (embolism) that obstructs the blood flow through the blood vessels, abnormally thick blood (hypercoagulable state), and inflammation of the blood vessel walls ( vasculitis ).
• Cephalopelvic disproportion, small maternal stature, maternal pelvic anomalies
• Use of midcavity forceps or vacuum extraction
• Benign causes of breast lumps include fibrocystic breast changes, fibroadenoma, fat necrosis (damage to some of the fat tissue within the breast), and breast abscess.

Symptoms of Fat Necrosis

Some are common symptoms of Fat Necrosis :-

• Spontaneous nipple discharge -- usually bloody or straw-colored fluid
• Breast is no longer symmetrical, compared with what it previously looked like
• The involved bone often later develops pain, especially with use.
• A painless lump that is firm or hard, with irregular borders (edges)
• Spontaneous nipple discharge -- usually bloody or straw-colored fluid
• Nipple changes -- retraction (pulling inward), enlargement, or itching

Treatment of Fat Necrosis

• Fluctuant areas of fat necrosis may require needle aspiration or surgical incision and drainage, but this seldom is needed
• The effectiveness of vitamin E , vitamin B - 6 , and herbal preparations (such as evening primrose oil) are controversial and should be discussed with your health care provider
• Surgery and radiation are considered local therapies because they directly treat the tumor, breast, lymph nodes, or other specific regions.
• The first line of treatment is fluid loading and calcium-wasting diuretics, such as furosemide.
• The choice of initial treatment for biopsy-confirmed breast cancer is based on the extent and aggressiveness of the disease.
• Drug treatment is called systemic therapy, because it affects the whole body.

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