A 40-year-old woman gives a history of blunt seatbelt trauma to the right breast 8 weeks ago. She now has a firm, slightly tender 2 cm lump. Mammography shows an ill-defined density with a radiolucent lipid cyst and coarse dystrophic calcification. FNAC shows oil droplets and haemosiderin-laden macrophages. The most appropriate management is:

• A Wide local excision with margins
• B Reassurance with clinical follow-up only ✓
• C Core biopsy followed by mastectomy if positive
• D Aspiration of the lipid cyst under ultrasound

Explanation

Fat necrosis follows trauma, surgery, or radiotherapy and can clinically mimic carcinoma with a hard lump and skin tethering. The diagnostic clues are the history of trauma, lipid cysts, coarse calcification, and oil droplets on cytology. It is benign and requires only reassurance once malignancy is excluded by triple assessment. Excision is reserved for symptomatic persistent masses, and aspiration is unnecessary because a lipid cyst is not a true fluid collection needing drainage.

Reference: Bailey and Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.