What is the difference between acute changes and chronic changes on postsurgical breast imaging?

Updated: Dec 19, 2018
  • Author: Susan Ackerman, MD; Chief Editor: Eugene C Lin, MD  more...
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Acute mammographic changes refer to the immediate postoperative period extending for the first several weeks and months. Acute changes include hematoma, seroma, and edema. Chronic changes refer to findings identified after the acute period, usually several months to years after surgery. These include scar formation, retraction, development of dystrophic calcifications, tissue asymmetry (from tissue removal), fat necrosis, and architectural distortion.

(See the images below.)

Mediolateral magnification view of the tumor bed a Mediolateral magnification view of the tumor bed after breast conservation treatment. A few coarse calcifications are noted consistent with fat necrosis. Mild architectural distortion is apparent in the lumpectomy site (see arrow). A scar marker was placed over the incision site.
Craniocaudal view in a patient after a reduction m Craniocaudal view in a patient after a reduction mammoplasty. Scattered parenchymal densities, architectural distortion, and extensive calcifications (due to fat necrosis) are noted (see arrows).
Craniocaudal mammogram demonstrating multiple oil Craniocaudal mammogram demonstrating multiple oil cysts. Note the multiple radiolucent masses with smooth internal margins and typical eggshell-like calcifications (see arrows). Frequently, a history of previous trauma or surgery can be elicited from the patient.
Mediolateral oblique mammogram in a patient 3 year Mediolateral oblique mammogram in a patient 3 years after a mastectomy and reconstruction with a transverse rectus abdominis muscle (TRAM) flap. The patient noticed the development of palpable firm masses in the upper-outer portion of the reconstructed breast (see arrows). The mammogram demonstrates the typical appearance of a TRAM flap. In addition, extensive macrocalcifications have developed related to fat necrosis. These calcifications corresponded to the palpable mass.

Architectural distortion is the disturbance of the normal-appearing curvilinear crescentic planes of the breast. The mammogram may demonstrate a pulling in of the Cooper ligaments to form a spiculated appearance. Architectural distortion may be the only mammographic indication of cancer. However, this finding is also seen after surgery, and it may be observed as a result of the superimposition of normal structures. Therefore, a thorough mammographic evaluation is needed to evaluate any areas of architectural distortion and to correlate the finding with the clinical history.

For excellent patient education resources, visit eMedicineHealth's Women's Health Center and Cancer Center. Also, see eMedicineHealth's patient education articles Breast Lumps and Pain, Breast Self-Exam, Breast Cancer, and Mastectomy.

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