A review of radiological characteristics and patterns of fat necrosis after different autologous breast surgery techniques.

Abstract

Background: The aim of this systematic review was to compare the radiological characteristics of fat necrosis distribution and morphology of tissue flaps versus autologous fat transfer (AFT) on ultrasound (US), mammography (MG), and magnetic resonance imaging (MRI), in order to improve diagnostic accuracy and guide treatment decisions.

Materials and methods: This systematic review was performed according to the PRISMA guidelines. A literature search was conducted in PubMed, Embase, and Scopus databases, identifying studies published after 2005. Eligible studies included female patients undergoing breast surgery using flaps or AFT, with fat necrosis assessed on US, MG, or MRI.

Results: Seventeen studies (13 AFT, 4 flap surgery) were included. Imaging was performed 1 to 240 months postoperatively. The mean prevalence of fat necrosis ranged from 12.5 to 23.6% for studies on flap surgery (n = 4), versus 7.3 to 82.9% for AFT (n = 5). On US, fat necrosis exhibited diverse echogenicity and cystic components often without vascularity, for both flap surgery and AFT. MG characteristics included radiolucent oil cysts with calcifications. MRI showed nonenhancing hypointense lesions with hyperintense borders on T1-weighted and T2-weighted fat-suppressed images. After flap surgery, fat necrosis was predominantly located at the peripheral margins of the flap, whereas in AFT it was more diffusely distributed.

Conclusion: Radiological characteristics of fat necrosis are generally comparable between tissue flaps and AFT, although a difference was observed in the prevalence and distribution of fat necrosis between the two techniques. However, literature is limited, and additional research is needed to be able to refine the radiological definition of fat necrosis.

Key points: Identifying radiological differences between fat necrosis in tissue flaps and autologous fat transfer may improve diagnosis by distinguishing typical from atypical fat necrosis presentations. Radiological characteristics of fat necrosis are largely comparable between flaps and autologous fat transfer, although imaging features evolve over time and distribution patterns might differ. Understanding radiological characteristics of fat necrosis across breast surgery techniques is essential for accurate diagnosis, guiding treatment decisions, and reducing biopsies and patient distress. Distribution patterns of fat necrosis may aid in improving diagnostic consistency.