Mammary fat necrosis following radiotherapy in the conservative management of localized breast cancer: Does it matter?

Department of Radiation Oncology, Allegheny General Hospital, Pittsburgh, PA 15212, USA.
Radiotherapy and Oncology (Impact Factor: 4.36). 03/2010; 97(1):92-4. DOI: 10.1016/j.radonc.2010.02.021
Source: PubMed


Fat necrosis is a well-described and relatively common complication arising from post-lumpectomy irradiation of the breast, most commonly breast brachytherapy. We wish to assess the clinical significance of fat necrosis resulting from post-lumpectomy breast irradiation.
We reviewed the literature to determine the overall incidence and significance of fat necrosis to determine whether or not fat necrosis poses a significant clinical problem.
Fat necrosis occurs in up to one-quarter of patients following post-lumpectomy breast irradiation. Only rarely is invasive intervention required however, it does significantly degrade the quality of all modalities of breast imaging.
Fat necrosis is a common complication of radiotherapy which rarely requires therapeutic intervention. However, post-therapeutic clinical imaging such as mammography, ultrasound and magnetic resonance imaging are affected which may result in additional diagnostic procedures up to and including biopsy.

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    • "Indeed, according to previous mammographic and ultrasound studies, we can assume that large wound cavities with fat necrosis will develop in most patients after IORT [6] [7] [8]. After conventional treatment (BCS with postoperative radiation), the incidence of fat necrosis is about 20% [9]; based on present knowledge, rates of 40%–60% have been reported after IORT [6] [7]. However, changes that arise in the tumor bed after IORT have not been investigated by magnetic resonance mammography (MRM) to date. "
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    ABSTRACT: The aim was to investigate changes in the tumor bed on magnetic resonance mammography (MRM) after intraoperative radiotherapy (IORT) and whether they would limit the diagnostic value of posttherapeutic MRM. We retrospectively investigated 36 patients undergoing MRM after IORT (median interval 2.8 years, range 0.4-7.1). Wound cavities with fat necrosis were common after IORT (81%). They were associated with persisting contrast enhancement, i.e., enhancement was mostly seen irrespective of the posttherapeutic interval. It normally presented as rim enhancement and did not cause any diagnostic uncertainty if viewed together with other tissue characteristics. We do not expect a limited diagnostic value of MRM after IORT.
    Full-text · Article · May 2012 · Clinical imaging
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    • "Small fat necrosis less than 2 cm can be resolved using conservative management and massage as time passes; in addition, non-steroidal anti-inflammatory drugs can be helpful if constant pain occurs. Surgical excision may be needed in only 2% to 7% of cases [40]. Improvement in symptoms using ultrasound-assisted liposuction occurs in more than 80% of cases, and complete resolution or reduction of sizes in large fat necroses has been reported recently [39,40]. "
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