Fact necrosis after surgery and radiation: Options?

Kohinoor

Hello,

I'm posting my question here because
I don't know under which category it should really go. I was diagnsoed
with invasive lobular carcinoma (ILC) in July and had a lumpectomy by
the end of the month. This was followed a month later by 25/5 sessions
of radiation. I'm done with radiation. I've been put on Tam two months
ago.

My
oncologist had requested an ultrasound which I had done two weeks ago.
The radiologist said she could see a nodule in the same place of the
surgery and performed a biopsy. The results showed this is a fat
necrosis probably resulting from surgery and/or radiation. My surgeon
wants to have it removed.

My
question is: does this fact necrosis need to be surgically removed?
What if I decide not to have it removed? I'm dreading the thought of
going through another surgery three months after the first one and my
skin is still tender after radiation.

I hope someone can help answer my question.

Thank you.

BayouBabe

I can't exactly answer your question, but wanted to share my experience.  I have had fat necrosis twice.  The first time it was removed surgically ONLY because it was found during my exchange surgery, and pathology showed it was simply fat (probably from rads damage).  My second formed after a fat grafting surgery, and my body after a few months simply reabsorbed it.  If I were you, I would be doing two things.  First, asking my current med team why it needed to be removed, and what would happen if it wasn't.  If I did not feel comfortable with the answers, then I would be going for a second opinion before going for another surgery.  You are your own best advocate.  Question everything and make the best decision for you. 

lane4

Hi, Kohinoor - I developed fat necrosis after partial mastectomy and radiation. It lit up on an MRI and looked suspicious on ultrasound. My BS wanted to get it biopsied to rule out a recurrence. The radiologist did an ultrasound-guided biopsy; pathology showed that it was only fat necrosis. I think it's a fairly common occurrence. I was told that it was not necessary to remove it. The radiologist left a different type of clip (different from those left by my BS) in that spot to show that it has been biopsied. That was about three years ago and I'm being followed by the same doctors, so they know the history.

Kohinoor

Hi lan4,

Thanks for your response.   My radiologist too did request the biopsy to rule out malignancy and to establish a baseline for future scans where this was going to show up every time an ultrasound is done.  She did not advise removing it.  My surgeon did though.  He said he does not fear it turning into cancer but he wants the area "clean".  Honestly I do not want to go through further surgery.  I'll be seeking a second opinion.  I don't know what happens if I decide to leave it in!

lane4

Kohinoor, I am okay with leaving the fat necrosis alone. I know where it is and how it feels and I'm pretty sure I would recognize any changes. Besides, I don't like the idea of adding more scar tissue to the scar tissue I already have. The imaging center that I go to does 3D mammos now, so I have faith that they would be able to see any changes. Also, I may be wrong, but I think fat necrosis can sometimes resolve on its own eventually. Just my thoughts...

Kohinoor

Hi lan4,

Thanks for your reply.  I went to see my oncologist last evening and he said ultimately it would need to be removed.  However, he advised we wait at least a couple of months more and do one or two additional ultrasounds to see the progress.  He said he did not expect changes.  The reason he wants to wait is to give the skin time to heal after radiation.

I called my surgeon a while ago and told him the story.  He said he completely disagrees with the oncologist.  He prefers to have it removed within a maximum of three weeks.  The reason why he is in a hurry is that the radiologist gave this sinister looking fat necrosis a grading of birads 4.  And he said if it'll be removed anyway, why wait two or three months!

Both doctors will discuss the case and then I should be able to decide.