Diep Flap Necrosis

Hi I wondered if anyone else has had fat necrosis following a DIEP flap reconstruction. If you did was there any further test to establish it was fat necrosis? I had my reconstruction done in Feb 2008 and after the first chemo the whole reconstruction went extremely hard and painful. This then eased to a large spot, approx 5cm of fat necrosis. Now in the last two years I have been seen numerous times in clinics etc and told this is fat necrosis, nothing to worry about. A new surgeon has seen me and referred me for an ultrasound, to be sure. At the ultrasound they told me nothing sinister was shown but would need to do a needle biopsy for completeness. I refused saying this wasn’t necessary, nothing had changed etc in 2 years.

I wondered if the ultrasound and needle biopsy was standard investigations for fat necrosis following a DIEP flap reconstruction?

Hi Lorra,

Immediately post DIEP recon I sufferred with fat necrosis in the medial aspect of my recon, this resolved over time with no intervention and is now nice and soft just like the rest of my boob plus I had no further investigations. I also noticed 4 months post op that I had a big lump just under my axillary scar (SNB) that was the size of a golf ball. During my reduction and uplift to other side my surgeon went in and removed this lump. It was sent routinely to the path lab where they confirmed it as fat necrosis. At no time did I have any further investigations as they were confident that we were just dealing with fat necrosis and nothing else. I also had a small fat lump around the drain site on my abdominal scar which they removed for me as it was really hard and caused some discomfort.
I must admit that I was probably treated in this way as my initial dx was of DCIS with no invasion and so did not have chemo or rads and so I am unaware of any other protocol that they may use. Sorry
Do hope this has been of some help and I hope that you get sorted soon.

Marjay xxxxx

Hi Lorra,

I had a small lump on my DIEP recon, so my surgeon requested an ultrasound and biopsy. This came back as fat necrosis, and I was glad that I had had the u/s and biopsy as I no longer worried about it. This was about 6 months after the recon which was done 3 years ago, and now it has completely disappeared.

Best wishes,


Thanks for the posts. I feel a bit disconcerted that they want to investigate 2 years after the event. When they said at the ultrasound they would do a needle biopsy I panicked, which was why it wasn’t done. The Doctor was very kind and said the ultrasound revealed nothing sinister but a needle biopsy would confirm that and referred me back to the surgeon. Unfortunately prior to this appointment next week the surgeon has sent me a slightly strange letter saying the ultrasound was indeterminate and I refused the biopsy so needed to be seen in clinic to discuss my future management. I hope this is just standard “NHS talk” but has only had the effect of making me worried and anxious.

Hi Lorra,

Glad of being some help, hope next week’s appointment goes ok just explain how you felt and that you panicked and that is why you didn’t want the biopsy, also ask if he could explain why this has happened 2 years after recon and what is he looking for. Let us know how you get on.


Marjay xxxxx

Hi Lorra… well it’s over 6 years since you posted this so I guess you may not see this, but I waswondering how you got on in the end?

I had my double mx and DIEP one side and SIEA the other.
DIEP boob is a nightmare. Huge lump of fat has formeddown the outside, and a ridge of what surgeon says is oedema has formed under the ‘aureole’.
I have to go back but suspect I need these removing, they are a tually causing me pain.

Anyone else have corrective surgery to their DIEPs?
(I also have a painful bulge on the DIEP side on my abdomen, to the right of my belly button. I had issues with the drain rubbing from the inside on this side, so suspect swelling could be scar tissue, but it just looks the same asthe rest of my tum in ct scans. But it feels weird and I can’t do up trousers over the area due to discomfort.

Looking for shared experience/ advice/ reassurance.
Had op 16 months ago now,should be all settled by now ?
Not really happy with recovery at all.