Mammographic findings after breast augmentation with autologous fat injection

Conventional film-screen mammography is a highly effective tool for the early diagnosis of breast cancer. Although the mammographic spectrum of fat necrosis has been well documented, and many postsurgical findings mimic carcinoma in clinical examination or imaging studies, the evolution of the mammographic appearance has not previously been reported in patients with a history of breast lipoinjection.

The purpose of our study was to evaluate the mammographic findings of fat necrosis in patients who had undergone breast lipoinjection and to determine whether there are any specific features that help to distinguish fat necrosis caused by fat injection from more worrisome findings.

Bilateral mammography was performed on 20 patients who had received autologous fat injection for breast augmentation between February 1999 and June 2006. The time elapsed between surgery and the postoperative mammograms ranged from 6 months to 7 years, an average of 34.5 months. The mammographic findings of fat necrosis were divided into six categories: 1, radiolucent oil cysts; 2, microcalcifications; 3, coarse calcifications; 4, focal masses; 5, spiculated areas of increased opacity; 6, negative. The Breast Imaging Reporting and Data System (BI-RADS) was used to classify the lesions in the mammograms.

The most common mammographic findings were benign bilateral scattered microcalcifications, followed by dispersed radiolucent oil cysts in the breast tissue. Microcalcifications were found on the mammogram of one patient as early as 11 months after lipoinjection. Only 3 patients showed clustered microcalcifications on their mammograms and were classified as BI-RADS III. These patients were later available for further digital mammography and reclassified as BI-RADS II.

Knowledge of the mammographic appearance and evolution of patterns of fat necrosis in patients who have undergone breast fat injection may enable imaging follow-up of these lesions, reducing the number of unnecessary biopsies or additional examinations and avoiding possible delays in the diagnosis of breast cancer. Because calcifications in breast parenchyma can be expected after breast fat injection, in our opinion this technique for breast augmentation should not be performed in patients with a family history of breast cancer.