Treatment Algorithm of Postsurgical Fat Necrosis of the Breast-Revisited

Oriana Haran*, Carolina Legarda, Dina Gofstein, Dana Adelson, Roei Singolda, Ehab Madah, Ehud Arad, Andrew E. Grush, Yoav Barnea

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Fat necrosis is a common complication of breast surgery, with the potential to cause both functional and aesthetic repercussions that can affect patient satisfaction. Although several fat necrosis classification systems have been proposed, fat necrosis management varies widely across institutions, requiring revisiting of existing treatment protocols. We evaluated the postoperative outcomes on 335 breasts following either breast reduction or reconstruction with deep inferior epigastric perforator (DIEP) flaps at our institution between 2016 and 2020, with particular attention to the development of fat necrosis and the need for subsequent surgical intervention. Fat necrosis was diagnosed in 36 (10.74%) breasts, of which 16 (44.4%) were surgically removed and 20 (55.5%) were conservatively managed. Time of fat necrosis diagnosis: early (≤one-month after breast surgery) or late (>1 month) was the only variable associated with surgical intervention. Fat necrosis management should be approached on a case-by-case basis. Whenever possible, conservative management with regular clinical and radiological follow-up, and patient reassurance, should be pursued even for large masses, in the absence of concomitant complications.

Original languageEnglish
Pages (from-to)94-100
Number of pages7
JournalSeminars in Plastic Surgery
Issue number2
StatePublished - 1 May 2022
Externally publishedYes


  • breast surgery
  • fat necrosis
  • treatment algorithm


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