Peter Bergquist, MD

A 45-year-old female with history of breast reduction surgery two years prior presents with focal abnormality on routine screening mammogram. Mammograms obtained prior to surgery and one year after surgery are available for comparison. No significant family history of breast cancer.


CC and MLO views of the right breast prior to surgery demonstrate a large breast without abnormality. Mammogram obtained one year after surgery shows a focal area of increased density with irregular margins containing internal rounded luncencies.

Mammogram at presentation shows slightly decreased size of the mass with interval development of extensive dystrophic calcifications.


Fat necrosis is a benign entity that is often related to breast trauma or surgery. There is no malignant potential, and no treatment is necessary. An initial event triggers damage of adipocytes, which leak fat into the adjacent tissue resulting in a local inflammatory response. As the edema subsides, saponification of fat leads to calcifications.

Imaging findings include a focal lucent mass with or without calcifications. Occasionally, as in this case, an increased density irregular mass can be seen due to the inflammation and/or edema. Well-defined internal luncencies can usually still be identified. This mass should decrease in size over time, differentiating it from other entities. The calcifications usually begin to develop over a year after the inciting event, and can initially appear fine or linear, which allows for confusing this entity with DCIS. Later these calcifications take on a more characteristic coarsened and dystrophic appearance, as seen in this case.


Bilgen IG, Ustun EE, Memis A. Fat necrosis of the breast: clinical, mammographic and sonographic features. 

Taboada JL, Stephens TW, Krishnamurthy S, et al. The many faces of fat necrosis in the breast. 

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45-year-old female with abnormality on routine screening mammogram, underwent breast reduction surgery 2 years prior.

Peter Bergquist, MD

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