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Autologous Fat Implantation of the Breast: spectrum of fat necrosis on ABVS imaging Tony W Chi, MD Nagashima Breast Imaging Center Taipei, Taiwan
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Aocr2014 ppt
- 1. Autologous Fat Implantation of the Breast: spectrum of fat necrosis on ABVS imaging Tony W Chi, MD Nagashima Breast Imaging Center NBIC Clinic Taipei, Taiwan
- 5. BREAST ENHANCEMENT Autologous Fat Implantation Silicone injection PAAG injection Macrolane injection Brava
- 7. 7
- 12. AGE VS CASE NUMBER Before op. 276 exam. After op. 60 exam. Total: 336 exam. Jan. 2011~ Dec. 2013
- 14. BEFORE SURGERY
- 16. BIRADS RESULT BEFORE OP BIRADS 1 - 55.4% BIRADS 2 - 15.9% BIRADS 3 - 27.2% BIRADS 4 - 1.5%
- 19. DURING SURGERY
- 20. AFTER SURGERY Recovery process Complication Avoid any strenuous activities Follow-up visits Monitoring
- 21. BIRADS RESULT AFTER OP BIRADS 1 - 3.3% BIRADS 2 - 78.4% BIRADS 3 - 18.3%
- 22. BEFORE & AFTER COMPARISON
- 23. After
- 31. Brava
- 33. About Expected Outcomes • Incision site? • Before and after? • Results? • Feel? • Risks and complications? • Breast cancer? • Additional operations? • Problem?
- 34. About Expected Outcomes • Incision site? • Before and after? • Results? • Feel? • Risks and complications? • Breast cancer? • Additional operations? • Problem?
- 35. About Expected Outcomes • Incision site? • Before and after? • Results? • Feel? • Risks and complications? • Breast cancer? • Additional operations? • Problem?
- 36. About Expected Outcomes • Size? • Over time? • Maintain? • Additional follow-up? • After pregnancy? After breastfeeding? • Breastfeed? • Options? • Mammograms?
- 37. CLINICAL FEATURES Palpable (97%) Tenderness (26%), Dimpling (14%) Nipple retraction (9%) Aqel NM, Howard A, Collier DS. Fat necrosis of the breast: a cytological and clinical study. Breast 2001; 10:342-345
- 46. CASE REVIEW Fat Necrosis with oil cysts complex cyst oil sinus remarkable fibrosis (architectural distortion) solid mass calcification (Liponecrosis Macrocystica Calcificans)
- 47. MILD FAT NECROSIS Oil cyst
- 48. + / - mural nodule(s) MILD FAT NECROSIS
- 52. MODERATE FAT NECROSIS Complex cyst
- 53. MODERATE FAT NECROSIS Complex cyst
- 56. MODERATE FAT NECROSIS Palpable oil cyst with or without calcification
- 58. Liponecrosis macrocystica calcificans CALCIFICATION OF FAT NECROSIS
- 63. SEVERE FAT NECROSIS Oil sinus
- 71. FIBROTIC FAT NECROSIS Malignant like mass
- 74. FIBROTIC FAT NECROSIS Architectural distortion
- 77. SPECTRUM OF FAT NECROSIS ON ABVS IMAGING Normal 1.7% Oil cyst 47.8% Complex cyst 20.9% Oil sinus 7.8% Remarkable fibrosis 6.1% Solid mass 14.8% Calcification 0.9%
- 79. CONCLUSION Knowledge of the ABVS appearance and evolution of patterns of fat necrosis : enable imaging follow-up of these lesions reducing the number of unnecessary biopsies reducing additional examinations avoiding possible delays in the diagnosis of breast cancer. [ABVS follow-up of women undergoing autologous fat implantation ] should be standardized to ensure reproducibility improve patient safety.
- 81. Q & A
Editor's Notes
- Approximately 5 to10 million women worldwide have breast implants. There were 296,203 breast augmentation procedures and 93,083 breast reconstruction procedures performed in the United States in 2010. Approximately half the procedures used saline-filled implants and half used silicone gel-filled implants.
- Breast implants are medical devices that are implanted under the breast tissue or under the chest muscle to increase breast size (augmentation) or to rebuild breast tissue after mastectomy or other damage to the breast (reconstruction). They are also used in revision surgeries, which correct or improve the result of an original surgery. There are two types of breast implants approved for sale in the United States: saline-filled and silicone gel-filled. Both types have a silicone outer shell. They vary in size, shell thickness, and shape (contour).
- The treatment involves injecting stabilised hyaluronic acid into the breast, buttock or other areas, and then moulding to the desired shape.[4] The procedures requires a local anaesthetic, and will likely cause bruising, swelling and discomfort for a few days. The effect only lasts for 12 months, after which further injections are required.
- Before Surgery Your surgeon may ask that you have a mammogram or breast X-rays prior to surgery in order to identify any breast abnormality and so the surgeon has a preoperative image of your breast tissue. You will usually be asked to not eat or drink anything after midnight the night before surgery and to bring loose clothing, including a loose-fitting bra without underwire, to wear after surgery. If you are going home the same day as the surgery, you will need to plan for someone to drive you home. Your surgeon should discuss with you the extent of surgery, the estimated time it will take and how they plan to treat for pain and nausea.
- During Surgery Once you have been given anesthesia and it has taken effect, the surgeon will make an incision (cut) in one of the following areas: along the underside of your breast (inframammary) under your arm (transaxillary) around the nipple (periareolar) through the mastectomy scar (for reconstruction) The FDA-approved labeling warns surgeons NOT to place breast implants through the belly-button (peri-umbilical approach). Female torso showing three incision points: under arm transaxillary incision, breast fold inframammary incision, and around nipple periareolar incision. Illustration from INAMED Patient Labeling. A woman covering her breasts with her hands, showing a small incision scar on the underside of the breast.The location of the incision can affect how visible the scars are, as well as any complications you may experience after surgery. Cutting the underside of the breast is the most common location used since it is where the skin naturally folds. Your scarring with this type of incision may be a bit more visible, especially if you are younger, thin and have not yet had children. Placing the implant through an incision under the arm will likely require your surgeon to use an endoscope, a tool with a camera and other surgical instruments inserted into the incision site to help the surgeon guide the implant into place. While there will likely be no visible scar around your breast, you may have a scar on the underside of your arm. Cutting around the edge of the nipple (areola) may cause problems with loss or change of sensation in the nipple. The surgeon will place the implant above (subglandular) or below (submuscular) the chest wall muscles. Be sure to discuss the pros and cons of the implant placement selected for you with your surgeon prior to surgery. If you are getting silicone-gel filled implants they will already be filled with silicone gel when inserted. If you are getting saline-filled implants and the implant is not pre-filled, the surgeon will insert the silicone shell and then fill the implant to the desired level with saline. The incision is then closed with stitches. Your surgeon may place temporary drains in the incision prior to closing it to prevent fluid or blood accumulation. Catheters to deliver pain medicine at the site of the incision may also be placed prior to closing the incision. The drains or catheters would be removed during a follow-up visit after surgery.
- After Surgery After surgery you will be taken to a recovery area to be monitored. Your breasts will be wrapped in gauze or a surgical bra. Your surgeon should describe the usual after surgery (postoperative) recovery process, the possible complications that may occur, and the recovery period. Following the operation, as with any surgery, you can expect some pain, swelling, bruising and tenderness. These effects may last for a month or longer, but should disappear with time. Scarring is a natural result of surgery. Prior to surgery, ask your surgeon to describe the location, size and appearance of any expected scars. For most women, scars will fade over time into thin lines. The darker your skin, the more prominent the scars are likely to be. Your surgeon may prescribe medications for pain and/or nausea. If you experience bleeding, fever, warmth, redness of the breast, or other symptoms of infection, you should immediately report these symptoms to your surgeon. Your surgeon should tell you about wound healing and how to care for your wound. You may need a postoperative bra, compression bandage or jogging bra for extra support as you heal. At your surgeon’s recommendation you will most likely be able to return to work within one to two weeks, but you should avoid any strenuous activities that could raise your pulse and blood pressure for at least two weeks. Ask your surgeon about a schedule for follow-up visits, limits on your activities, precautions you should take, and when you can return to your normal activities, including exercising. If you received silicone gel-filled breast implants, the FDA recommends that you receive MRI screening for silent rupture 3 years after receiving your implant and every 2 years after that. Continue to get mammograms to screen for breast cancer. Be sure to tell the person giving your mammogram that you have breast implants. Breast implants may make it difficult to see breast tissue on standard mammograms, so they may need to use different techniques. If you are enrolled in a clinical study, be sure to ask your surgeon for a schedule of follow-up examinations set by the study plan.
- About Breast Implants and Expected Outcomes What shape, size, and surface texture are you recommending for my implants? Why are you recommending one type of breast implant over another? Why do you recommend this one for me? How long will my breast implants last? What incision site and placement are you recommending for me? Do you have before and after photos I can look at for each procedure? What results are reasonable for me to expect? How will breast implants feel? Will they alter my breast skin or nipple sensation? What are the risks and complications associated with having breast implants? Can I still get breast implants for augmentation if I have a strong family history of breast cancer? How many additional operations on my breast implants can I expect to have over my lifetime? How will I be able to tell if my breast implant has ruptured or if there is a problem with my breast implants? How will my breasts look if I decide to have the implants removed and not replaced? How easy or difficult is it to remove the implants? How easy or difficult is it to increase the size of the implants after the breast implants have been placed? What can I expect my breasts to look like over time? What do I need to do to maintain them? What kind of additional follow-up will I need? What are the long term consequences of breast implants? What will my breasts look like after pregnancy? After breastfeeding? Will the breast implants affect my ability to breastfeed a baby? What are my options if I am dissatisfied with the outcome of my breast implants? Can I still get mammograms with breast implants in place? Will the mammogram rupture my breast implant? What alternate procedures or products are available besides breast implants?
- About Breast Implants and Expected Outcomes What shape, size, and surface texture are you recommending for my implants? Why are you recommending one type of breast implant over another? Why do you recommend this one for me? How long will my breast implants last? What incision site and placement are you recommending for me? Do you have before and after photos I can look at for each procedure? What results are reasonable for me to expect? How will breast implants feel? Will they alter my breast skin or nipple sensation? What are the risks and complications associated with having breast implants? Can I still get breast implants for augmentation if I have a strong family history of breast cancer? How many additional operations on my breast implants can I expect to have over my lifetime? How will I be able to tell if my breast implant has ruptured or if there is a problem with my breast implants? How will my breasts look if I decide to have the implants removed and not replaced? How easy or difficult is it to remove the implants? How easy or difficult is it to increase the size of the implants after the breast implants have been placed? What can I expect my breasts to look like over time? What do I need to do to maintain them? What kind of additional follow-up will I need? What are the long term consequences of breast implants? What will my breasts look like after pregnancy? After breastfeeding? Will the breast implants affect my ability to breastfeed a baby? What are my options if I am dissatisfied with the outcome of my breast implants? Can I still get mammograms with breast implants in place? Will the mammogram rupture my breast implant? What alternate procedures or products are available besides breast implants?
- About Breast Implants and Expected Outcomes What shape, size, and surface texture are you recommending for my implants? Why are you recommending one type of breast implant over another? Why do you recommend this one for me? How long will my breast implants last? What incision site and placement are you recommending for me? Do you have before and after photos I can look at for each procedure? What results are reasonable for me to expect? How will breast implants feel? Will they alter my breast skin or nipple sensation? What are the risks and complications associated with having breast implants? Can I still get breast implants for augmentation if I have a strong family history of breast cancer? How many additional operations on my breast implants can I expect to have over my lifetime? How will I be able to tell if my breast implant has ruptured or if there is a problem with my breast implants? How will my breasts look if I decide to have the implants removed and not replaced? How easy or difficult is it to remove the implants? How easy or difficult is it to increase the size of the implants after the breast implants have been placed? What can I expect my breasts to look like over time? What do I need to do to maintain them? What kind of additional follow-up will I need? What are the long term consequences of breast implants? What will my breasts look like after pregnancy? After breastfeeding? Will the breast implants affect my ability to breastfeed a baby? What are my options if I am dissatisfied with the outcome of my breast implants? Can I still get mammograms with breast implants in place? Will the mammogram rupture my breast implant? What alternate procedures or products are available besides breast implants?
- About Breast Implants and Expected Outcomes What shape, size, and surface texture are you recommending for my implants? Why are you recommending one type of breast implant over another? Why do you recommend this one for me? How long will my breast implants last? What incision site and placement are you recommending for me? Do you have before and after photos I can look at for each procedure? What results are reasonable for me to expect? How will breast implants feel? Will they alter my breast skin or nipple sensation? What are the risks and complications associated with having breast implants? Can I still get breast implants for augmentation if I have a strong family history of breast cancer? How many additional operations on my breast implants can I expect to have over my lifetime? How will I be able to tell if my breast implant has ruptured or if there is a problem with my breast implants? How will my breasts look if I decide to have the implants removed and not replaced? How easy or difficult is it to remove the implants? How easy or difficult is it to increase the size of the implants after the breast implants have been placed? What can I expect my breasts to look like over time? What do I need to do to maintain them? What kind of additional follow-up will I need? What are the long term consequences of breast implants? What will my breasts look like after pregnancy? After breastfeeding? Will the breast implants affect my ability to breastfeed a baby? What are my options if I am dissatisfied with the outcome of my breast implants? Can I still get mammograms with breast implants in place? Will the mammogram rupture my breast implant? What alternate procedures or products are available besides breast implants?
- On cytology, the early stage of fat necrosis is characterized by degenerative changes in adipocytes accompanied by hemorrhage (Figs. 1A and 1B)
- On cytology, the early stage of fat necrosis is characterized by degenerative changes in adipocytes accompanied by hemorrhage (Figs. 1A and 1B)
- In the intermediate stage of fat necrosis, there is infiltration of histiocytes and multinucleated giant cells (Fig. 1C)
- The degenerated RBCs conglomerate in the setting of high levels of free fat released by the necrotic adipocytes. These conglomerations are referred to as “myospherulosis,” which is characteristic of fat necrosis on cytology (Fig. 1D)
- In the late stage of fat necrosis, usually hemosiderin deposition and the development of fibrosis (Figs. 1E, 1F, and 1G) are seen. Reactive inflammatory components replaced by fibrosis lead to scar formation.
- In the late stage of fat necrosis, usually hemosiderin deposition and the development of fibrosis (Figs. 1E, 1F, and 1G) are seen. Reactive inflammatory components replaced by fibrosis lead to scar formation.
- In the late stage of fat necrosis, usually hemosiderin deposition and the development of fibrosis (Figs. 1E, 1F, and 1G) are seen. Reactive inflammatory components replaced by fibrosis lead to scar formation.
- Sometimes, fibrosis and calcifications are the only sequelae of fat necrosis (Fig. 1H)
- Bilgen et al. [8], in a retrospective study of 126 cases of fat necrosis, found a wide distribution of sonographic presentations, including increased echogenicity of the subcutaneous tissues, with or without small cysts (in 26.9% of cases); anechoic masses with posterior acoustic enhancement (in 16.6% of cases); anechoic masses with posterior acoustic shadowing (in 15.8% of cases); solid-appearing masses (in 14.2% of cases); cystic masses with internal echoes (in 11.1% of cases); and cystic masses with mural nodules (in 3.9% of cases).
- liponecrosis macrocystica calcifcans.
- Implant removal followed with complication
- Other Terms For Breast Fat Necrosis membranous fat necrosis liponecrosis microcystica calcificata posttraumatic pseudolipoma.