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Wednesday, July 09, 2008 DL, Community Member, asks

Q: What causes fat necrosis and what can be done when it occurs

I was diagnosed with Breast Cancer in March 2007. I had to do a mastectomy as the lump was under the nipple and as the nipple could not be spared, a mastectomy was recommended.  Subsequently found that it was DCIS though my 16 lymph nodes were removed during surgery. The Mass was 6cms. Radiation and Tamoxifen was recommended. Radiation lasted 5 weeks daily. Tamoxifen for 5 years. Since doing radiation developed a cough and fever etc. This was sorted out eventually after doing a CT Scan and finding that the lungs were fine. About a month ago discovered a hardened, painful lump within the radiated section near the epi-gastric area. This was ultrasounded and a CT Scan and Fine Needle Biopsy done. Found to be benign and was advised this was "Fat Necrosis."  Would like to know what causes fat necrosis and what can be done when it occurs as it is not getting any smaller and seems to be increasing in size. 

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Answers (3)
PJ Hamel, Health Guide
7/ 9/08 8:54pm

DL, my understanding is that fat necrosis occurs when the tissue isn't receiving sufficient blood or oxygen. Or in your case could be the radiation just somehow killed it, like it killed the cancer cells. If it's getting larger, sounds like it might be continuing to die. What does your surgeon say? Or oncologist? I believe the only thing you can do is remove it; it won't come back to life. Suggest you make a dr. appt. to find out what's up, rather than just let it slide. Good luck- PJH

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Angi, Community Member
7/ 9/08 10:41pm

Hi DL

I have fat necrosis in one of my partially reconstructed breast, which is on hold as my cancer returned and I am in the middle of radiation.

My plastic surgeon is not concerned with the unpleasant hard spot cause he will remove it when it comes time to finish the reconstruction process.

Fat necrosis usually occurs around an incision site, and I've been told that you should gently massage the tissue anytime after a surgery has healed to help keep the tissue soft.

Since I still have my tissue expanders in until I complete radiation, I had to be warned of what could possibly occur with them in.  I can develop little hard spots in the tissue around my expander.  It is a risk, but I know my plastic surgeon will remove any hard spots when we do the final surgery.

The only way to get rid of the necrosis is to have it surgically removed - and yes the spots can grow larger - as PJ said it is due to a lack of blood circulation to that area.  I beleive that it is never to late to start massaging it, but it will not make it go away, just help prevent it from getting bigger. 

See you surgeon, he will probably do like a lumpectomy to remove the dead tissue.  As far as I know the necrosis poses no real threat, it's just unpleasant to have hard breast.  So make sure that if you do go the removal route to massage the tissue as soon as the incision has healed.

Good luck to you!

Angi

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linaka, Community Member
7/12/08 4:38pm

I had a lumpectomy, with chemo and radiation Jan 05-Sept 05, this year the indentation seemed deeper and I was having pain (right around incision and radiation site) and had ultrasound and another experimental imaging technique (called sonocine) and they both indicated a mass that has been labelled as

 "probably fat necrosis."  Doctors have not recommended I do anything- no removal, no massage, just monitoring, and they said the pains may continue for years.

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By DL, Community Member— Last Modified: 11/01/12, First Published: 07/09/08