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The breasts
Published in C. Simon Herrington, Muir's Textbook of Pathology, 2020
The importance of fat necrosis lies mainly in its propensity to mimic cancer, as it may present as a firm mass, nipple retraction or mammographically with radiological calcification. It is caused by injury to the fat cells of the breast, although the trauma may be relatively minor and not reported by the patient. This causes leakage of lipid and a subsequent inflammatory reaction. Initially there may be associated haemorrhage and acute inflammation, but macrophages soon collect and take on a foamy appearance due to lipid in the cytoplasm, and a foreign-body giant cell reaction (Figure 16.13). Subsequently fibrosis is seen, hence the clinically mimicry of carcinoma, often with microcalcification in the stroma.
Breast imaging
Published in A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha, Clark’s Procedures in Diagnostic Imaging: A System-Based Approach, 2020
A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha
Typical lymph nodes (Figs 12.9a, b) have a fatty centre and hilum, oil cysts are well-defined and of fatty density and duct ectasia may produce typical coarse ductal rod- or tube-like calcifications. Many abnormalities, however, do not show diagnostic features and require further assessment by ultrasound and/or biopsy. Simple cysts are very common and appear as round, well-defined masses or clusters of masses, but there are no mammographic signs that are absolutely diagnostic of a cyst, so ultrasound or aspiration is usually required for diagnosis. Some lesions are notoriously difficult to diagnose and closely mimic malignancy. One such is radial scar (Fig. 12.9c), which produces a spiculated area, often with an apparent small central mass. These are surgically removed, as even CBx does not exclude malignancy next to a scar. Fat necrosis may produce all the features of malignancy and even at histology can be difficult to diagnose.
Breast
Published in Tor Wo Chiu, Stone’s Plastic Surgery Facts, 2018
Consider surgical delay in cases with higher risk of fat necrosis (see above) as well as those requiring a large proportion of the whole TRAM tissue. It can be performed either open or endoscopically, 2 weeks before the definitive flap procedure. In the work of Codner (Plast Reconstr Surg, 1995), found that delay increased the ‘flap perfusion pressure’ from 13.3 to 40.3 mmHg.
The influence of venous system patterns on DIEP flap viability for breast reconstruction
Published in Journal of Plastic Surgery and Hand Surgery, 2021
Yoshihiro Sowa, Takuya Kodama, Kei Fujikawa, Daiki Morita, Toshiaki Numajiri, Koichi Sakaguchi
The patterns of the direction and bifurcation points of the most dominant perforator vein in the flap are divided into two types (Figure 1(a)). To determine the blood vessel diameter for a perforator, the widths of blood vessels, including arteries and veins at the level of flow into fat tissue on the fascia, were measured using a micro-measure. cSDC and MCLVs in the lower abdominal region were identified (Figure 2). Zones I–III were further classified into the proximal, middle, and distal parts to measure fat stiffness objectively in 9 regions in total, using real-time ultrasound SWE (LOGIQ E9, GE Healthcare) and a 9L linear (4–9 MHz) probe [21.22] (Figure 1(a)). Measurements were performed three times and the mean stiffness was determined. The stiffness of subcutaneous fat located at a site 5 cm from the umbilicus on the cranial side was used as a control. Fat necrosis and induration in the transplanted flap were diagnosed 6 months after the operation. With reference to the definition by Peeters et al., fat necrosis was defined as any palpable firmness, nodule, or mass greater than approximately 3 cm in diameter that was present 6 months after surgery (Figure 3(a)) [23].
Efficacy and safety assessment of an ultrasound-based thermal treatment of varicose veins in a sheep model
Published in International Journal of Hyperthermia, 2020
Nesrine Barnat, Anthony Grisey, Bjoern Gerold, Sylvain Yon, Jérémie Anquez, Jean-François Aubry
We additionally observed here changes in the perivascular tissues and the collateral muscles. They were primarily characterized by localized areas of coagulation necrosis. Surrounding connective tissues showed fat necrosis with chronic inflammatory response at 30 days post-treatment exclusively. Healing reaction to adipose tissue necrosis as evidenced by inflammatory cells infiltration that resolved over time since perivascular fat necrosis (steatonecrosis) was no longer observed at 60 nor 90 days. From a pathology standpoint, steatonecrosis is thus not considered to be a safety concern as it fully heals and resorbs over time. Surrounding muscles also showed evidences of prior thermal injury. At 30 days, it was evidenced by local necrotic areas with gradual fibrous healing confined exclusively to the superficial perivenous muscle. One can also note here that the presence of hyperechoic marks at focus resulting from boiling could have been impeded the propagation of the HIFU beam beyond focus. At 60 days, evidences of prior thermal injury were also confined to superficial perivenous muscle and were characterized by demarcated areas of coagulation, myofiber regeneration and fibrous healing. Substantial muscle regeneration was observed at 90 days and healing was complete at 90 days.
Objective evaluation of fat tissue induration after breast reconstruction using a deep inferior epigastric perforator (DIEP) flap
Published in Journal of Plastic Surgery and Hand Surgery, 2019
Yoshihiro Sowa, Isao Yokota, Kei Fujikawa, Daiki Morita, Tetsuya Taguchi, Toshiaki Numajiri
Laser-assisted ICG angiography can assist with identification of poorly perfused areas intraoperatively, but this approach is difficult to use in postoperative follow-up and does not permit estimation of 3-dimensional flap hemodynamics [22,23]. We use regions with confirmed blood flow on ICG imaging during surgery for breast reconstruction with a DIEP flap, similarly to other medical facilities. However, postoperative fat necrosis or induration often develops, even if these safety regions alone based on ICG imaging are used. This may be because blood flow shown by ICG suggests a region covered by arteries, but does not necessarily show venous return. Blood flow in transplanted tissues may be estimated more clearly by retracing the stiffness of the tissues objectively using measurements of stiffness during surgery and postoperatively, as in the current approach.