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Management of Post-Surgical Fat Necrosis of the Breast: A Systematic Review & Novel Treatment Algorithm
Samantha Shellen
*, Carolyn Cafro, Rebecca Patrick, Anna Weiss, Jonathan Leckenby
University of Rochester, Rochester, NY
Background: Fat necrosis (FN) is a common complication of breast surgery due to ischemic injury to adipose tissue. Incidence ranges from 3% to 40%, depending on procedure and follow-up length. Clinically, FN may mimic malignancy, leading to further procedures. Despite its prevalence and diagnostic complexity, there are no management guidelines. This review evaluates current treatments and outcomes for post-surgical breast FN and proposes a management framework.
Methods: A PRISMA-guided search of PubMed, Embase, and Scopus identified studies reporting management outcomes of FN after breast surgery. Reviews, non-surgical studies, non-English publications, and animal studies were excluded.
Results: Eight studies met inclusion criteria, comprising 1,361 reported FN cases across cosmetic, oncologic, and reconstructive populations. FN incidence after fat grafting ranged from 9.6% to 10.5%, with higher graft volumes associated with increased risk (p=0.044). In oncologic cohorts, 19.3% of patients developed new lesions during follow-up, of which 17% were FN and 2.3% were recurrences, often requiring biopsy for definitive diagnosis. Management approaches were varied. Observation was common for asymptomatic cases, while minimally invasive options such as ultrasound-guided aspiration had high rates of symptom improvement, with complete resolution reported in up to 81.5% of cases and low complication rates. Surgical excision was reserved for persistent symptoms or diagnostic uncertainty. In a registry of surgically treated FN cases, the 30-day complication rate was 6.3%. Across studies, many lesions were benign but often led to invasive procedures.
Conclusion: Management of post-surgical breast FN is variable. Many cases are managed with observation or minimally invasive techniques, though excision remains common. A symptom-based management algorithm may reduce unnecessary procedures while ensuring oncologic safety and aesthetic outcomes. Prospective studies incorporating standardized imaging criteria and patient-reported outcomes are needed to guide evidence-based care.
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