Nothing is as scary as having a lump in your breast. After any breast surgery you can have them. So what do you do?
- First BREATHE. I say this a lot in my blogs, but I think it is important to repeat. Most of the time a new lump in the breast after breast surgery is just scar tissue, a dissolving suture, or fat necrosis. All of these things sound bad, but they are not uncommon and none are dangerous.
- TIME. When was your surgery? If you surgery was within the last few months, the chance the lump goes away is high. As you heal, the process of healing creates a lot of inflammation. This is to dissolve the dissolving sutures and just the process of your body knitting together. This will get better with time. So if you notice the lump is getting smaller and softer, this should be reassuring. Did the lump present after your surgery? Is it along a suture line?
- LOOK AT PAST MAMMOGRAMS. Before breast surgery, I like anyone over the age of 35 to get a baseline mammogram and anyone who hasn’t had a mammogram for a while to get a recent one. Why? Because we are changing things all around, and it is difficult to image the breast after a breast surgery for 6 months. If you did a simple breast augmentation, the breast tissue is minimally touched. The orientation of things is the same. If you did a breast lift or breast reduction, things are really moved around. Expect your new imaging to look totally different. Again, post surgical changes tend NOT to look like cancers.
- GET A NEW MAMMOGRAM/ULTRASOUND/MRI to image the breast. The post surgery changes generally look different than cancer does on imaging.
- GET A BIOPSY. Usually things look totally okay, and you don’t need to do a biopsy. But if there is any question, you should get a biopsy. Most of the time you will find scar or fat necrosis. But for peace of mind, you cannot “know” what it is unless you send it to path.
TERMS:
Dissolving sutures: This is what I use internally to align the tissue so it can heal. The sutures dissolve by your body breaking up the suture. This causes inflammation. You can feel the suture during this time more- it may feel like a pea under the tissue.
Encapsulated suture: Sometimes the body walls off the suture with a capsule of scar. This can prevent your body from fully breaking down the suture. This is not dangerous, but it means the dissolving suture won’t fully dissolve.
Fat necrosis: The breast has a lot of fat in it. If there is any issue with blood supply, the fat may die. This is called fat necrosis. Usually if this happens it is a small area, and it will feel like a small hard lump in the tissue. This is not uncommon in breast surgery, particularly if the breast is really fatty with a poor blood supply, or if you have any issues with blood perfusion from diabetes, hypertension, high cholesterol, anemia, too tight of a garment/pressure, etc. There is no danger. This can be seen in fat transfer to the breast.
Oil cysts: Seen primarily in fat transfer to the breasts.
Calcification: Your mammogram looks for a certain pattern of calcification which is suspicious for cancer. Usually the pattern in post surgical changes looks different.