Fat necrosis of the female breast – Hadfield re-visited

Examination of pathology records from three hospitals over an 8-year period identified 42 cases of primary fat necrosis of the female breast. The mean age of the women was 56 (range 24–85) and the lump was most commonly in the upper, inner quadrant of the breast having been present for a mean of 11 weeks (range 1–56). Twenty-one percent of patients gave a history of trauma which had occurred a mean of 69 weeks (range 3–208) previously. The mammograms gave an appearance of malignancy in 12 of the 22 cases where they were performed. Cytology was suspicious in five cases. Thirty-seven patients subsequently underwent wide local excision to confirm the diagnosis. The histology was re-examined by a pathologist and a subgroup of patients were identified who had fat necrosis associated with periductal mastitis. Two patients who had a core biopsy diagnosis of fat necrosis were found to have malignancy on wide local excision. Here we review the changes in presentation since the original description of the condition, and highlight that although this series reflects difficult cases, fat necrosis remains a condition which can still be difficult to diagnose.