A classification system for fat necrosis in autologous breast reconstruction.

PURPOSE: Fat necrosis (FN) is a common complication of autologous breast reconstruction, yet no classification system exists to describe it. We sought to develop and validate a tool for meaningful reporting, comparison of techniques, and treatment planning. Our hypothesis was that a valid classification system would demonstrate higher grades of FN for pedicled transverse rectus abdominus myocutaneous (pTRAM) flaps as compared to free flaps (FF). METHODS: A classification system for FN was developed: grade I, radiologic evidence only; grade II, palpable but not visible FN; grade III, palpable and visible FN; and grade IV, symptomatic FN. For validation, we applied this system to patients who had undergone pTRAM flaps from 2002 to 2006 and FF from 2006 to 2010 at our institution. RESULTS: We performed 93 pTRAM flaps in 69 patients and 102 FF in 69 patients. One patient had grade I FN and was observed. Of the 29 patients with grade II FN, 48% were observed, 17% had biopsy, and 35% underwent debridement. Of the 9 patients with grade III FN, 11% underwent biopsy and 89% had debridement. All patients with grade IV FN underwent debridement. The distribution of FN differed between pTRAM and FF. The mean FN grade for patients undergoing pTRAM was 1.4 versus 0.4 for those undergoing FF (P < 0.05). Fat necrosis requiring reoperation was more frequent in the pTRAM group (23.7% vs 5.9%, P < 0.05). CONCLUSIONS: Our validation study confirmed that FN grade was associated with the need for surgery and was higher for pedicled flaps as compared to FFs. As it is similar to the Baker grading system for capsular contracture, this classification system is familiar to all plastic surgeons. It is simple, easy to remember, clinically oriented, and could be readily incorporated into outcome studies of autologous breast reconstruction.

Subcutaneous fat necrosis of newborn children.

We report a case of subcutaneous fat necrosis of a newborn child which appeared 9 days after birth and was cured without any complications. We propose the reclassification of the etiological factors accompanying this lesion by classifying them in a plurietiological syndrome with some basic or essential factors and other causative factors.

A classification system for partial and complete DIEP flap necrosis based on a review of 17,096 DIEP flaps in 693 articles including analysis of 152 total flap failures.

BACKGROUND: In a comprehensive review of 17,096 deep inferior epigastric perforator (DIEP) flaps in 693 articles published between the first description of the DIEP flap in 1989 and August of 2011, the authors found that the methods used to categorize partial necrosis and fat necrosis were inconsistent. As a result, these surgical outcomes cannot be meaningfully compared among series and centers. In contrast, complete flap failure is an unambiguous and universally reported outcome that represents only a portion of the entire spectrum of flap necrosis. METHODS: The authors created a database of every article with data on DIEP flaps by searching PubMed and Embase for the terms "DIEP," "DIEAP," "epigastric AND perforator," "perforator," and "flap AND reconstruction" and manually reviewing the 14,480 citations the search generated. The authors then reviewed 693 articles with data on DIEP flaps for incidence and other clinical details of flap loss, partial necrosis, and fat necrosis. RESULTS: The authors found a broad range of definitions of partial and fat necrosis based on different parameters (e.g., percentage of flap lost, area of flap lost, necessity of reoperation) that were not directly comparable. Of 152 documented DIEP flap losses, 67 had reported causes: 40 percent (27 of 67) involved venous problems, 28 percent (19 of 67) arterial, and 21 percent (14 of 67) mechanical (pedicle kinking, hematoma). CONCLUSIONS: At present, there is no consensus on the reporting of partial necrosis and flap necrosis. The authors propose a new flap necrosis classification system that prevents ambiguity and allows direct objective comparison of surgical outcomes among centers.

Differentiating fat necrosis from recurrent malignancy in fat-grafted breasts: an imaging classification system to guide management.

BACKGROUND: In breast reconstruction with autologous fat grafting, concerns persist about the ability to differentiate palpable masses representing fat necrosis from recurrent cancer. The authors' objective was to develop standardized imaging classifications to distinguish benign from malignant lesions after fat grafting. METHODS: A database of 286 breast reconstruction patients undergoing fat grafting from 2006 to 2011 was retrospectively reviewed to identify patients with imaging of clinically palpable masses. All images were reviewed independently by a radiologist blinded to prior results. Lesions were classified, using the American College of Radiology Breast Imaging Reporting and Data System ultrasound lexicon, as follows: A, solid mass, hypoechoic; B, solid mass, isoechoic; C, solid mass, hyperechoic; D, solid mass, complex echogenicity; E, anechoic mass with posterior acoustic enhancement; F, cystic mass with internal echoes; and G, negative. Evolutions in lesions on follow-up ultrasound were recorded. Images were correlated with histopathologic results. RESULTS: On ultrasound, 66 lesions were visualized in 37 patients with palpable masses. Twenty-two lesions (33 percent) were Breast Imaging Reporting and Data System category 4 lesions; biopsies were performed on all of them. Histopathologic results revealed that 85.7 percent (six of seven) with classification D and 100 percent with classifications A, B, C, E, F, and G were fat necrosis. The one malignant lesion (classification D) exhibited vascularity and angular margins on ultrasound and was not in the location of fat injection. Negative predictive value of avascularity and circumscribed margins for malignancy was 100 percent. Follow-up ultrasound of 29 lesions at a median of 6.5 months revealed that no masses increased in size or developed vascularity. CONCLUSION: Ultrasound analysis, with a standardized classification system, is reliable at differentiating benign from malignant lesions after fat grafting in breast reconstruction.

Necrosis grasa subcutánea del recién nacido: comunicación de un caso

Desarrolla lo referente a un caso de una recién nacida de 12 días de vida con necrosis grasa subcutánea,contiene el caso clínico con los datos laboratoriales, el diagnóstico, el tratamiento y las conclusiones

Traumatismos de la mama: signos radiológicos y diagnóstico diferencial con atipías / Breast trauma radiologic signs and differential diagnosis

Se recopilaron 33 pacientes que presentaron hematomas mamarios y necrosis grasa. Se analizaron sus antecedentes clínicos, quirúrgicos y/o traumáticos. En el trabajo realizado se lograron individualizar las distintas formas de presentación de esta patología, y se analizaron los métodos de diagnóstico utilizados. En todos los casos se llegó a un diagnóstico más certero agregando a la mamografía la evaluación ultrasónica, que fue definitoria en varios casos de hematomas. Asimismo señalamos el gran valor de la mamografía para definir los casos de necrosis grasa