Fat Necrosis After Breast Surgery: How We Treat It

So you've had breast surgery, you've found a little lump, and you've been diagnosed with fat necrosis. How did it get there, and what do we do about it?

Breasts are a combination of breast tissue and fatty tissue. Whenever we cut tissue, put stitches in, or rearrange things inside the breast (in a breast lift or a breast reduction, for example), there's a possibility that we change the blood supply to a particular area, so that the fat in that area dies. That's fat necrosis.

What you end up with is a little lump you can feel through the skin.

It's usually a pretty easy diagnosis with ultrasound. We can see the area and whether there's blood flow through it.

(Early on, fat necrosis can look a lot like an infection. Here's how to tell the two apart.)

Tiny areas go away with time. Your body will often break down and get rid of a little area of fat necrosis on its own.

So for most patients, the first step is to leave it alone and massage the area, which brings blood flow in so your body can take care of the problem.

Sometimes an area is stubborn and doesn't seem to be getting smaller, and there's inflammation around it. Putting a little anti-inflammatory medicine around the area can help your body clear it better.

When we see fat necrosis after fat grafting, we sometimes do something called aeration, where we poke the area with a needle. That brings blood flow to the area, and sometimes we can also remove some of the grafted fat. (More on fat necrosis after fat grafting.)

But I don't find aeration works as well when the fat necrosis comes from breast surgery that isn't fat grafting.

Say you're six months or more out, and the area doesn't seem to be getting smaller.

If it's small and close to the skin, we usually just remove it, and that can be done in the office. We numb you up, make a little nick in the skin or open a small portion of your incision, and remove the area of fat necrosis.

If you have an implant under there, depending on how much tissue you have, your surgeon might feel more comfortable doing it in the operating room for sterility reasons. But it's frequently done in the clinic.

Larger areas are a whole other animal, because removing a large area can leave a dent or defect in your breast.

So if a larger area is getting smaller, the best course is often to watch it longer and see where it ends up. Often your body will take care of it on its own, and if everything shrinks slowly with time, you're less likely to end up with a deformity.

If it's been a long time and you still have a larger area, then removal is the way to go, and larger areas almost always need to be removed in the operating room.

• Surgical removal, in the office for small areas near the skin, or in the operating room for larger areas or when there's an implant underneath
• A minimally invasive, ultrasound-guided device in some cases (I described how it works in my post on fat necrosis after breast reduction)
• Liposuction, which can also remove areas of fat necrosis in some situations

If it's not really bugging you, you can leave it in. You might feel it occasionally, and that's fine.

• Fat necrosis happens when an area of fat loses its blood supply during surgery, and ultrasound usually makes the diagnosis
• Small areas: massage and time. Stubborn, inflamed areas: an anti-inflammatory injection
• Aeration helps after fat grafting more than after other breast surgery
• Six months or more out, small areas near the skin can often be removed in the office. With an implant, your surgeon may prefer the operating room
• Large areas: wait longer while they're shrinking, because removing them can leave a dent
• You don't have to remove it. It isn't dangerous, and the body usually takes care of it with no intervention