Gigli Silvia, Amabile Maria Ida, DI Pastena Francesca, DE Luca Alessandro, Gulia Caterina, Manganaro Lucia, Monti Massimo, Ballesio Laura
Department of Radiology, Anatomo-pathology and Oncology, Sapienza University of Rome, Rome, Italy.
Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
Anticancer Res. 2017 Oct;37(10):5395-5398. doi: 10.21873/anticanres.11966.
Breast lipofilling uses autologous fat grafting to correct breast defects after radical or conservative surgery. After early concerns regarding its application in reconstruction after breast cancer (BC), in 2009 the American Society of Plastic Surgeons formed a task force to assess the indications, safety and efficacy of autologous fat grafting. We report the case of a woman who came to our attention for a painful swelling of the left breast. She had undergone breast-conserving therapy for BC, followed by lipofilling. The breast ultrasound (US) examination showed diffuse structural alteration and multiple hypoechoic areas with acoustic shadowing, mainly localized in the subcutaneous tissue. After pharmacological treatment and short-term follow-up US examination, considering the persistence of the clinical symptoms and structural alterations, we performed contrast-enhanced magnetic resonance imaging, that showed multiple enhancing areas in the left breast. Suspecting local tumor recurrence, we carried out US-guided breast core-biopsy, whose histological examination documented liponecrosis. This observation raised a series of diagnostic and therapeutic issues highlighting the diagnostic pitfalls that the radiologist may encounter during the evaluation of patients who have undergone BC surgery and breast reconstruction through lipofilling.
乳房脂肪填充术采用自体脂肪移植来矫正根治性或保守性手术后的乳房缺陷。在早期对其应用于乳腺癌（BC）术后重建存在担忧之后，2009年美国整形外科医师协会成立了一个特别工作组来评估自体脂肪移植的适应症、安全性和有效性。我们报告了一名因左乳房疼痛性肿胀而引起我们注意的女性病例。她曾接受过BC的保乳治疗，随后进行了脂肪填充。乳房超声（US）检查显示弥漫性结构改变以及多个伴有声影的低回声区，主要位于皮下组织。经过药物治疗和短期随访US检查后，考虑到临床症状和结构改变持续存在，我们进行了对比增强磁共振成像，结果显示左乳房有多个强化区。怀疑局部肿瘤复发，我们进行了超声引导下乳房粗针活检，其组织学检查证实为脂肪坏死。这一观察结果引发了一系列诊断和治疗问题，突出了放射科医生在评估接受过BC手术和通过脂肪填充进行乳房重建的患者时可能遇到的诊断陷阱。
