What is Fat Necrosis? Let's talk about it simply!

Have you ever felt a lump or a hard lump under your skin that scared you? Or maybe after surgery, your skin has changed color and feels tight? This could be a condition called Fat Necrosis . Don't worry, let's find out more about it.

What is Fat Necrosis? Simply put...

'Necrosis' is the death of tissue in our body. This usually happens when the blood supply to that tissue is lost. So, Fat Necrosis is when the fatty tissue (adipose tissue - to be precise, the collection of cells that store fat) in your body is damaged, and those fat cells die. Imagine, you have been hit somewhere hard, or you have had surgery, that's when this condition can occur.

This doesn't happen all at once. It's a slow, gradual process. There are different stages to this. As these fat cells start to die, you'll notice changes in the texture and appearance of the skin in that area. You might feel a lump or a hard spot under the skin. Or the area might become red, swollen, or look like a bruise. These are all things to expect. Most of the time, these are temporary. Over time, your tissue will return to normal.

Who is most affected by this situation?

Fat necrosis can actually occur in anyone with damage to fatty tissue. However, some people are more likely to develop it.

This situation is often seen:

• For women and people with breasts: Fat necrosis most commonly affects breast tissue. This is because the amount of fatty tissue in the breasts is relatively high. If you have a lot of breast tissue, this risk is slightly higher.
• For those who have had breast surgery: This risk is especially high when undergoing fat grafting surgery.
• For those who have received radiation therapy for cancer: Radiation therapy can also damage healthy fatty tissue.
• This condition is also seen in people over the age of 50 .

However, very rarely, Fat Necrosis can also occur in the following cases:

• For those who have had severe acute pancreatitis: This can also be caused by a problem with the pancreas.
• For babies born during a very difficult delivery: Sometimes, fatty tissue can also be damaged due to other pressures during delivery.

Where can Fat Necrosis occur?

In fact, Fat Necrosis can occur anywhere there is fatty tissue and where it has been damaged.

However, it is most commonly seen in the breast area . This is because the breast is the largest and most easily damaged area of ​​our body, where fatty tissue accumulates. For example, if a seat belt hits you hard in a car accident, or during cancer treatment, such as a biopsy, radiation therapy, or surgery, breast tissue can be damaged.

Not only that, this condition can also occur in areas with excess fat, such as the stomach, buttocks, and thighs, due to medical or cosmetic surgery. For example, when performing a tummy tuck, there is a possibility that the fatty tissue in the abdomen may be damaged. Also, when performing surgeries that take fat from one area and transplant it to another, for example, a Brazilian butt lift (BBL), the transplanted fatty tissue may be damaged and cause `necrosis`, and the transplanted tissue may fail.

Sometimes, if a severe case of acute pancreatitis occurs, Fat Necrosis can also occur in the fatty tissue around the pancreas. If the digestive enzymes released by the pancreas leak into the body, the surrounding tissue can be burned and injured. Usually, this Fat Necrosis associated with the pancreas only affects the abdominal cavity. However, rarely, it can also enter the fatty layer under the skin and spread throughout the body. We call this `Panniculitis`.

What are the symptoms of Fat Necrosis? How does it feel and look?

You may notice that you have Fat Necrosis if you notice a change in the texture or appearance of your fatty tissue. These changes can vary from person to person. It depends on where the damage occurred, the severity of the damage, and how far the process has progressed. Sometimes these symptoms can appear months or even years after the initial damage .

What does Fat Necrosis look like?

• You may feel a lump or a growth under your skin .
• If a lot of the fat under the skin has died, it may appear as if the area has sunk inward and is sagging .
• If fat necrosis occurs in a breast, the nipple can sink inward .
• Due to chemicals released by dying fat cells, the skin in that area may appear red, bruised, or thickened .

What does Fat Necrosis feel like in the hand?

• It feels like a fatty lump or a hard nodule .
• Fat Necrosis is a condition that begins in the early stages of the disease. As fat cells die, their fatty material leaks out and collects, forming a small sac called an ``oil cyst.''
• Over time, calcium deposits can build up in the walls of this cyst, making them hard .
• When these nuts start to break down, they can become flat .

Does Fat Necrosis cause pain?

Usually there is no pain . However, very rarely, the area may hurt when pressed a little. Fat necrosis, which occurs under the skin and is associated with `Panniculitis`, is often painful. Because there is ongoing inflammation (chronic inflammation).

What are the causes of Fat Necrosis?

Fat necrosis occurs when your fat tissue (adipose tissue) is damaged and the cells die. There are several ways this damage can occur:

• Blunt trauma: For example, in a car accident.
• Surgical procedures: It can be due to both therapeutic and cosmetic surgery.
• Biopsy procedures: This can also happen when a tissue sample is taken and tested.
• Radiation treatments: Because of radiation treatments given for things like cancer.
• Damage caused by pancreatic enzymes in acute pancreatitis.

What are the possible complications of Fat Necrosis?

Although Fat Necrosis is not dangerous, it can sometimes cause minor problems:

• Cosmetic issues: Sometimes this can cause things like breast reconstruction surgery to fail completely. The appearance of the skin can change.
• Re-operation: If fat necrosis occurs after cosmetic surgery, it may require re-operation to correct it.
• Infection of the tissue: This is very rare. If it happens, you may need to take antibiotics or have surgery.
• Stress: This can be a huge stressor, especially for someone undergoing cancer treatment. Imagine, after successfully completing radiation therapy or surgery, what if you have to go back to the hospital as a side effect of those treatments? You may have to have another surgery, or you may have a deformity. The most important thing is that this Fat Necrosis can look like cancer. It is not actually cancer, but sometimes it is difficult to distinguish the two. Therefore, you may be afraid that the cancer has returned.

How do doctors diagnose Fat Necrosis?

Fat necrosis can usually be diagnosed through radiology. However, there are two minor problems that can arise here.

The first is that Fat Necrosis occurs a long time after the initial injury that caused it. It usually doesn't start to show symptoms until about a year and a half later. If you don't remember the injury, or if you weren't aware that your tissues were being damaged at the time, neither you nor your doctor may suspect Fat Necrosis.

That's where your detailed health history comes in. The doctor will ask you about any accidents, surgeries, and illnesses you've had in the past few years.

Another problem is that fat necrosis can look like cancer. Both can look the same when you touch it and on imaging tests. Although someone with a history of cancer is more likely to develop fat necrosis, seeing it can also raise concerns that the cancer has come back. So, both you and your doctor need to know exactly which one is which. Sometimes, a biopsy (a tissue sample) may be needed to confirm this.

What tests are done to diagnose Fat Necrosis?

Your doctor may recommend various types of scans (`imaging tests`) to diagnose Fat Necrosis. Some of them include:

• X-ray (`X-ray`)
• Ultrasound scan (`Ultrasound`)
• CT scan (`CT scan` - Computed Tomography scan)
• MRI Scan (MRI - Magnetic Resonance Imaging)

Sometimes, if the doctor wants to confirm Fat Necrosis in the laboratory, they may perform a needle biopsy to remove a small piece of tissue .

Does Fat Necrosis get better on its own?

Most of the time, yes! This will get better on its own over time.

If it doesn't cause you any pain or significant stress, there's no need to treat it or remove it. However, if it bothers you or seems to be taking a long time to heal on its own, you can have it removed.

How to remove Fat Necrosis?

Doctors use the same techniques to remove fat necrosis as they would for a biopsy. Sometimes, the fat necrosis can be removed during a diagnostic biopsy. There are several methods:

• Fine needle aspiration: In this procedure, a long, thin needle and syringe are used to remove cells, tissue, and fluid without cutting the skin. This needle can be used to drain the oil cyst. The cyst will then drain.
• Vacuum-assisted core needle biopsy: In this procedure, a small, hollow needle is used to remove tissue through a small incision. The needle is guided by ultrasound or X-rays, and a vacuum device is attached to the needle, which sucks out the tissue, similar to liposuction. This is usually done under local anesthesia.
• Excision biopsy: The last resort is to remove the tissue. Surgery can cause Fat Necrosis to recur. However, in some cases, this type of excision is necessary. For example, if the lump is too large to be removed with a needle, or if there is a strong suspicion that it may be cancerous. This surgery can be done under local anesthesia or general anesthesia. However, it will leave a small scar.

How long can Fat Necrosis last?

This varies from person to person. It can take months to years for a fat necrosis to completely disappear and be broken down by the body. Sometimes, when different fat cells are in different stages of this `necrosis` process, it can appear to be getting bigger and spreading. However, over time, it should start to shrink.

What is the future for someone with Fat Necrosis?

Fat necrosis is not harmful . In fact, it often goes away on its own . It doesn't cause serious complications. If you have it removed, you may be left with a small scar or a small dimple in the skin. If your fat necrosis was caused by a failed fat transfer procedure, you may need to try again, adjust it, or have another surgery.

When should you be concerned about Fat Necrosis?

If your Fat Necrosis looks like this, definitely see a doctor:

• If it causes pain.
• If it looks like it's getting bigger.
• If, after diagnosis, new changes begin to appear.

Fat necrosis is not a harmful condition. However, these oil cysts under the skin can look like cancerous tumors. Therefore, it is normal to feel scared when you see this. Especially if you do not remember any previous accidents or if you have had cancer before. Medical tests can quickly alleviate your fears.

However, it is important for those undergoing cancer treatment or breast reconstruction surgery to be aware of the risk of Fat Necrosis. If this happens, you may need to return to the hospital for further tests or surgery, even after a long time.

Final Take-Home Message

Fat necrosis is when fat cells in the body die when they are damaged. This can cause a lump, a hard lump, and sometimes a change in skin color under the skin.

• This is not cancer. However, it can sometimes look like cancer, so it's important to get tested to find out for sure.
• Most of the time, Fat Necrosis gets better on its own and does not require special treatment.
• If there is pain, if the lump is getting bigger, or if you have any doubts, definitely see a doctor.
• This condition can also occur after things like cancer treatment and surgery, so it's good to be aware of it.

Don't worry, this is usually not a dangerous condition. However, it is wise to seek medical advice about any suspicious lump.

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