Fat Necrosis

[mmarilyn]

I was diagnosed with a papilloma in my right breast and then went in for surgery to have it removed. When the pathology came back with nothing but healthy breast tissue, I became alarmed and thought that the papilloma could still be in my breast. So, after 2 months I went back for an ultrasound and they identified a pea-sized mass in the place where the papilloma originally was. The doctor thought that the papilloma might still be there. She did a fine needle biopsy which revealed atypical cells so she sent me back in for another excision biopsy. Now the results have come back with a fat necrosis. Does a fat necrosis have atypical cells? Do fat necrosis need to be removed?

Thanks, mmarilyn

[DrBhumikaMD]

Hi,
You can relax and do not worry. Apocrine metaplasia is a benign condition. It has no increased risk for the development of breast cancer. Apocrine means a type of glandular secretion in which the end part of the secreting cell is cast off along with the secretion products that have accumulated. Metaplasia means a change in the type of cells in a tissue to another form of cells that are not normal for that tissue.
You need to carry on with your regular breast self exams and report any abnormal features like a lump, nipple discharge or skin changes to your doctor. Also get a clinical evaluation done every 6 months. A repeat mammogram or USG would be advisable every year or when suggested by your physician.
Goodluck!

[sonu78]

Hi,
Intraductal papilloma of breast is a benign lesion, which arises from large and medium sized ducts. It shows intraductal papillary arborescent fronds lined by two types of epithelial cells-outer cuboidal or columnar and inner myoepithelial cells with central fibrovascular core. Papillomas are of two types - central often solitary lesion and the peripheral, usually multifocal. Peripheral papillomas are highly susceptible to cancerous change. However the susceptibility of central papilloma to malignant change are controversial topics to pathologists and surgeons.
Hence it would be advisable to have your routine follow up and screening programs as suggested by your surgeon.

[mmarilyn]

They surgically removed the fat necrosis with papilloma two weeks ago.  I have had two surgeries now to get rid of this tiny 3.5mm benign papilloma. This is appalling. The first surgeon missed the papilloma because he did not request that I have a preoperative wire inserted (he asked the ultrasonographer to put a magic marker dot on my skin). The papilloma was 7mm below the surface.  Do they ever put dots on women's breasts prior to surgery in the USA? Seems like a stone age practice.

How often do I need to have checks now that the papilloma has been removed? I am 50. Do I need to go every two years or more frequently?

The papilloma showed apocrine metaplasia. Is there an increased risk of cancer with this symptom?

Thank you,
mmarilyn

[DrBhumikaMD]

Hi,
Do carry on with regular breast self exams and an annual or 6 monthly visit to your physician for a clinical evaluation. You will probably be advised USG periodically to see the status of the fat necrosis and papilloma. Also report any symptoms like pain or tenderness, if and when you have any to your physician. Goodluck.

[mmarilyn]

Thank you for your quick and helpful response. The surgeon has just called back and said that they found the papilloma in the fat necrosis and it is free of cancer. I am so relieved.

mmarilyn

[DrBhumikaMD]

Hi,
The chances are more in favour of a post surgery scar tissue or fat necrosis in your case. A scar tissue is usually managed conservatively and regular follow ups planned. It does cause a lump and some pain and tenderness in some cases. It is excised in case it is symptomatic. It is also removed in case there is a suspicion of malignancy to remove any doubt. Goodluck.