Magnetic Resonance Imaging Enhancement Two Years Post Lumpectomy: An Unusual Timing for Fat Necrosis

Breast fat necrosis is a common benign inflammatory process in the post-surgical or post-traumatic breast. It is often clinically silent with a wide spectrum of imaging findings that range from the characteristically benign to the suspiciously malignant. These characteristics pose a significant challenge for clinical providers to identify this common entity and distinguish it from more ominous diagnoses, especially in patients with a prior history of breast malignancies. We present a challenging case of fat necrosis with suspicious imaging features and an unusual timeline, occurring in the second year following lumpectomy. Radiologists’ awareness of this condition and its varying presentations is of critical importance to appropriately guide evaluation of suspicious magnetic resonance imaging enhancements.