The following question is answered by Richard Kline of The Center for Natural Breast Reconstruction.
Q: I am a 7-year Stage I breast cancer survivor. I’ve had lumpectomy and radiation, with no chemotherapy.
Three years ago, had a bilateral breast reduction. Six months later, developed nipple retraction and a mass. General surgeon (who follows me for BC) was concerned at first and biopsied it twice. The results were negative. Mammograms have been reported as within normal limits.
My plastic surgeon (who did the reduction) would like to have yearly MRI’s because he said eventually, this mass will start to calcify, most likely keeping me flagged for biopsies. The general surgeon disagrees and feels it’s been biopsied twice and he would not do any more unless my mammogram changed.
My concern is that this fatty necrosis will hide any new cancer that may form. It’s pretty big area approx. 7.5cmx5cm. My new internist is not happy with this area and wants me to see another surgeon. So my question is: will this make seeing any new cancer form harder? Is my risk for more necrosis higher if I have it removed since this was the radiated breast and that is what caused the necrosis in the first place? My original surgeon suggested a mastectomy to be 100% sure that nothing would ever get missed. I will be seeing new surgeon next week and would like to have some ideas before I go. I have no problem with another lumpectomy or even a mastectomy if needed.
A: I’m sorry to hear you’re having so much trouble.
It’s outside of my area of expertise to advise you whether calcifications from fat necrosis can mask a tumor recurrence, but I just called our breast imaging radiologist and asked. She said fat necrosis definitely makes imaging “more challenging,” and you may require ultrasound and/or MRI in addition to mammography in the future, should you choose to leave the mass in place.
I CAN advise you that the risk for wound healing problems (including more fat necrosis) is certainly higher in a radiated breast, so the answer to the second part of your question is yes, you could end up with additional fat necrosis after surgery.
Even a mastectomy will not reduce your risk of another cancer to zero, as some breast cells are frequently left behind, but it will reduce your risk significantly. We would be happy to put you in touch with one of our surgical oncologists who specializes in breast disease, if you would like to get more specific information about risk reduction.
Hope this helps, and feel free to call or email with any more questions.
Richard M. Kline, Jr., MD
Center for Natural Breast Reconstruction
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