Breast Fat Necrosis After Flap Reconstruction Surgery

After flap reconstruction surgery (autologous reconstruction), in relatively rare cases, some of the fat in the flap used to reconstruct the breast might not receive enough blood flow. Over time, that fat may be replaced by firm scar tissue that feels like a hard lump. The lump may be as small as a pea or could be a larger, hard mass. It is usually not noticeable until 6 to 8 months after the surgery, once the tissue flap has softened and the swelling is gone. Doctors call these lumps fat necrosis. 

Sometimes smaller areas of fat necrosis shrink or go away on their own. Larger areas of fat necrosis can be painful and can cause a distortion in the shape or texture of the breast.

Fat necrosis can also develop after an injury or damage to fatty breast tissue during a biopsy or radiation. Fat necrosis is non-cancerous (benign), and it does not increase breast cancer risk.

With fat necrosis, breast changes to look out for include:

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  lumps

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  thickened, red, bruised, or dimpled skin around the lump

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  pain

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  nipple retraction (when the nipple is pulled in)

Lumps can feel either hard and round like a pea or small grape or like a larger, hardened mass. After flap reconstruction, you might not notice a lump until several months later, once the flap has healed and the swelling is gone. If you do feel a lump, let your doctor know so you can have a scan and confirm whether it’s fat necrosis in the breast.

It can be difficult for a doctor to tell whether a lump is breast fat necrosis or a potentially cancerous tumor during a physical exam. You may need to have a mammogram, an ultrasound, or a breast MRI to get a clearer look. If the imaging test results do not clearly show fat necrosis, you may need to have a biopsy to rule out cancer.

Sometimes smaller areas of fat necrosis can dissolve or go away without any treatment. Larger areas of fat necrosis can be painful and even distort the breast's shape or texture and need to be surgically removed.

A plastic surgeon cuts out the area of fat necrosis or removes the dead tissue with liposuction. An advantage of liposuction is that it’s less likely to create a divot in the spot where the fat necrosis was. If you do end up with a divot or dimpling, your plastic surgeon might be able to:

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  reposition breast tissue to fill it in

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  perform a small flap reconstruction to fill in that area

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  use fat grafting or fat injections to help add volume