Fat Necrosis - does it change?

NotVeryBrave

I'm wondering about the possible resolution of fat necrosis and what that would look or feel like.

My left nipple was somewhat damaged during my surgery and, once it healed and the swelling went down, I noticed a small and hard lump under the areola. Last November I had an US and mammogram done and the consensus was that it was fat necrosis and no worries unless it changed.

About a month ago I called the BS because it seemed different - not necessarily larger but in a different area. She reassured me that shifting could have caused it to seem that way.

Fast forward to now and it seems a lot bigger under the areola and not as firm. My nipple now looks almost like it's erect all the time. I keep telling myself that it can't be BC - I had a pCR, I just finished Herceptin in January ...

I'm going for a follow up US and mammogram next week with a possible biopsy at the same time. I'm nervous (of course) and I can't seem to find any good info on what becomes of a "fat necrosis" area. I'm also worried about a biopsy being done under my nipple, so close to the implant.

Any insight?

KBeee

Even if they “think” it is far necrosis this time, insist on biopsy since it is the only definitive way to know. Hoping this is what it is. Keep us posted

DodgersGirl

NotVeryBrave—. Sorry you find yourself having to worry about another biopsy. I find myself in the same situation. Just had an ultrasound on mastectomy scar as I have 2 small lumps. Dr believes they are fat necrosis but was just scheduled for biopsies of both next week. I was dx’d a year ago tomorrow. Sure don’t want to start treatments all over again.

Wishing you only good news!!

NotVeryBrave

Thanks for the responses. When I first had it scanned, the plan was biopsy or recheck in 3 months. I was going to wait the 3 months because I was incredulous that it could be cancer again and they warned me of all of these risks with biopsy. They ended up ordering the mammo which seemed to make everything quite clear. Now I'm not so sure.

I has taken me about 2 weeks to get the scans scheduled since they would only do it in a slot that allowed time and personnel for a biopsy. And since I was thinking "biopsy only if needed" and "I can't effing believe this" - I didn't want to do it that way. I'd rather come back with some Xanax on board. But now I see the light.

Crap. I feel like I'm falling down that hole again.

NotVeryBrave

Has anyone had an area that was confirmed as fat necrosis become larger - maybe more spread out? I feel like the original area was smaller and firmer, like a small knot. Now it seems like a much larger footprint and maybe not as compact if that makes sense.

I have my scans scheduled for Wednesday. Just trying to think of any positive outcomes ...

NotVeryBrave

I had the US and 3D mammo this morning. They believe it is still the same area of fat necrosis. It was explained to me that areas of fat necrosis tend to have less regular borders over time and can become calcified. According to them - it's actually about the same size as before. The plan is to follow up again in 3 months.

I could have opted for a biopsy today, but ... that could cause more trauma and more necrosis. I will see my BS in May and see what she has to say.

While I wish it wasn't there at all, I'd be SO surprised if it really was cancer. Tissue damage makes sense with what the area looked like after my surgery. So I guess I will wait.

This also means that I won't be pursuing fat grafting anytime soon. Maybe down the road I will have different implants placed and they could remove this area at the same time.

I guess we're never really done with all of this.

buttonsmachine

Hope it's fat necrosis - most the time that's what it is. Even so, please keep an eye on it, and biopsy it asap if anything changes. What you say is true though, we're never really done with this! Best wishes to you and keep us posted.

DodgersGirl

NotVeryBrave—. Glad they still believe it’s fat necrosis. My biopsy is tomorrow morning, sure hoping for the same outcome!

NotVeryBrave

DodgersGirl - I hope all goes well tomorrow. I know it's nerve wracking. Let me know.

DodgersGirl

NotVeryBrave—. Had 2 biopsies yesterday. When they told me they were placing clips in case the lumps are cancerous, I was concerned. And Dr doing biopsies didn’t show any hints at expected results even though Dr doing original U/S told me he thought the lumps were fat necrosis or oily cysts. Was told results would be known Monday or Tuesday.

Well, GP’s nurse called just now to tell me both spots were BENIGN!!!! And with the clips, we will easily be able to know which lumps have already been checked

KBeee

Putting the clips in during a biopsy is standard procedure.

Dodgersgirl, Congrats on the benign results. Happy for you!

DodgersGirl

KBeee— thanks!! Going to enjoy the weekend, for sure.

NotVeryBrave

Yay! Always so good to hear good news!

NotVeryBrave

I just wanted to update this thread in case there are those with similar concerns. Aren't there always?

I saw my BS today for my six month follow up. She reviewed the most recent scans and did an exam. So ... it turns out that they leave a bit (she called it a disk) of breast tissue beneath the areola when doing nipple-sparing in order to help the nipple survive. This is the first time I've heard this and, judging from the state of that nipple after surgery, I never would have guessed anything had been left there.

And fat necrosis does change over time, especially with massage. So the most likely scenario is that there was some damaged tissue there (not surprising) that became "fat necrosis" and has continued to change over time.

I never really thought that it would be cancer, but I guess that thought is also never completely out of your mind. I still feel like the areola looks kind of weird these days - very different from the other side - and was worried a bit because now they want me to rescan in three months whereas before they were good with benign and no need for follow up scans. The BS says it's because it's now been addressed twice so they have to follow for continuity or something.

Anyway, I have to think that if there was any inkling of concern - they'd be on it with my history. So there's that, anyway.

NotVeryBrave

Ah ... the never ending saga continues. I had my 3 month follow up US done last week. I was expecting just "more of the same" and was surprised to be seen by another radiologist. This one seemed very perplexed. He palpated the area and compared it to the other breast. He talked about MRI. He kind of dismissed fat necrosis until he left and reviewed the mammo results from before - then he agreed with that. But still talked about MRI and possible biopsy and consulting with my BS.

I ended up calling my BS. I love this woman - she is no nonsense and kind and competent. Her plan is to have another radiologist (a specialist) look over all of the images since last October. The problem with an MRI is that we have no other images to compare it to. And if we do a biopsy, there seems to be some concern about what part to biopsy and will that cause further damage. So we discussed the possibility of just removing it and sending it to pathology.

I don't want more surgery, but I'm really tired of looking at this thing every day. The nipple and areola look different - larger, puffy, a little misshapened. I keep telling myself (and anyone else) that I really don't believe it could be cancer. But what is it? And why does it still seem to be getting larger? It's been more than a year since my BMX

I meet with the BS tomorrow. I hope she's had the other radiologist look over everything. I hope she has an answer and a plan.

KBeee

Sorry you are dealing with this. As much as surgery sucks, I understand wanting to just get rid of the problem area. I would do the same. Let us know how it goes

NotVeryBrave

I just saw my BS. I'm going to have a lumpectomy to remove it. That sounds weird after having had a mastectomy, but that's what she called it. She can make an incision just outside of the areola and take it out. She thinks the nipple will be fine.

The last radiologist ended up recommending MRI, but she says that would be just another image and we have nothing to compare it to. The consulting specialist radiologists recommended needle biopsy or removal. Since there is a possibility of no answer from biopsy (wrong area, not enough tissue, etc) and risk of implant rupture or another area of concern developing from the biopsy, we're going with removal.

Now if I could just figure out when to do it. Between vacations that are scheduled and my love of the OR (haha) - IDK. Tentatively planned for the end of July but not sure of recovery. Family beach vacation a week later. Too soon?

KBeee

If you want to go in the water, it is too soon. If not, ask surgeon for opinion

Hoping it is benign!

NotVeryBrave

Thanks. I did check with my BS and she said to wait until I'm back - that they wouldn't want the sand and water risks that soon after surgery.

She also said I could get the D&C done during the same surgery. If only! My GYN practices elsewhere.