breast reduction fat necrosis

[neezer]

I had a breast reduction in August 2006.  I have a mass of tissue in my right breast that my plastic surgeon has told me to massage since right after the surgery.  I have switched doctors due to his disrespect and inappropriate bx.  Recently the area was looked at through ultrasound.  It is approximately the size of an egg.  The new plastic surgeon said it is necrotic fat tissue and will not get smaller or break up with massage.  He said I can leave it in, but he recommends removing it.  He is uncertain if he can maintain the shape of my breast.  The mass has moved down over time and is under my areola now.  It is painful to massage and makes that nipple jutt out in a curved manner.  He thinks the surgery will hopefully only flatten the area, but volume could be a concern due to the mass size.  I had 4 pounds removed during surgery, I don't smoke and never have.  My right areola had been cut in many areas during surgery to improve blood flow.  My question is whether there is any procedure out there besides a surgery that could deform me?  Also, does it sound normal to have a mass that size die in a non smoker?

[Howard Rosenberg, MD]

Fat necrosis following breast reduction is a relative infrequent problem.  It is undoubtedly due to diminish blood supply to the underlying breast tissue and fat as a result of the original reduction procedure.  The extent of the breast reduction you required probably contributed to its formation.

When it is removed, it consists of a mass of extensive scar formation with some contained liquified fat.  Surgical excision is the definite treatment, but it is not mandatory that this be done.  The fact that you are symptomatic makes resection of the area more acceptable.  Your current surgeon is correct in suggesting that full resction may leave some shape deformity.  Partial surgical resection can be done, but there will still be a hard area that may continue to be uncomfortable.

Other treatment techniques (such as an attempt to dissolve and break up the fat with ultrsonic liposuction) will probably not work.  I think you will need to decide if your symptoms are significant enough to justify surgical resection and the possibility of shape change.

[bubs4]

A related discussion, fat necrosis after breast reduction was started.

[stingingnettles]

A related discussion, Are there any non surgical treatments for fat necrosis after breast surgery was started.