Fat Necrosis After Breast Reduction: Causes and Treatment Options

Fat necrosis is a relatively common complication after breast reduction. Let's talk about what's happening and the ways we manage it.

Fat necrosis happens when tissue loses its blood supply during surgery. That area of fatty tissue — and sometimes breast tissue — dies, and it frequently becomes hard. The area gets inflamed because your body doesn't like having a little wad of tissue that's no longer living.

Often with time, your body will eat it away — especially if it's small. You can help speed that along during the healing process by massaging the area to bring extra blood flow.

Beyond massage, there are a few things we can do to help:

We poke the area multiple times with a needle. The idea is that by bringing blood flow and a small amount of controlled trauma, your body kickstarts its ability to break down the necrosis.

Sometimes the inflammation surrounding the necrotic area is actually what's preventing it from resolving. I've found that injecting steroids into the area can reduce that inflammation and help it go away in some cases.

If you're pretty far out from surgery and still have an area of fat necrosis, we usually need to intervene. Fat necrosis isn't dangerous — it can stay — but women typically don't like masses in their breasts. We often remove them, especially if they're:

• Uncomfortable or painful
• Bothersome in clothing — like when a bra strap hits it in a certain spot

Traditional excision: We go to the operating room, make a small incision, and remove it — essentially a lumpectomy for a benign lesion.

Minimally invasive removal: Depending on where the lesion is, there's a device that works under ultrasound guidance through a small incision. It rotates with a blade and suction, breaking up the necrotic tissue and removing it through a tube. This can be a great option for the right patient.

Fat necrosis after breast reduction is relatively common and not dangerous. Many cases resolve on their own with time and massage. For persistent cases, we have options ranging from steroid injections to minimally invasive removal. Always go back to your original surgeon first for their input and advice.