hard lump after TRAM FLAP reconstruction surgery

[pushpa399]

I had double mastectomy (after a stage 2 breast cancer diagnosis) and an immediate reconstruction using my addominal muscles (TRAM Flaps) in 1998 at U of M hospitals. Past few months, I notice an occasionally painful hard lump at 5 o clock location in my right breast.  Mammogram, MRI, and Ultrasound rule out malignance and fat necrosis.  What could be the cause for this hardness?  My Breast Care Surgeon has no clue on why would this one will develop after ~ 10 years but plans to do a biopsy to rule out malignancy for sure.

Any suggestion as to what this lump could be due and should I remove it (even if it is benign?_

[Archibald S Miller III, MD,FACS]

There are 3 likely reasons for this lump. A new lesion of some sort, or a slow growing lesion from your original surgery. The second is a small area of fat necrosis that has gotten larger, possibly due to an infection or hematoma, and finally a seroma or fluid collection that is slowly getting larger. A very remote possibility is a small traumatic vascular wekness that is slowly growing and needs to be repaired. The reason for biopsy is to rule out a malignancy. If the area is painful, malignant or not, removal is indicated. I would get the biopsy sooner rathger than later. I hope this helps, respectfully,

                         arch s miller ms md facs

[pushpa399]

Thank you very much for the prompt and detailed answer.