Ms. Hild is a 46 year old female with a personal history of bilateral mastectomies with implant based reconstruction in 2015 for left breast IDC. She recently presented in diagnostic clinic for two sites of suspected fat necrosis in the left low axillary area and left breast 9:00 location. Patient is status post bilateral mastectomies with bilateral retropectoral implants. The implants appear intact. In the left upper inner reconstructed breast, approximately 10:00 position, there is an irregular enhancing lesion identified measuring approximately 7 x 9 x 10 mm (AP x ML x SI). This area of enhancement abuts against the anterior aspect of the implant. Given the location (10:00 position), this area of enhancement may not correlate with the hypoechoic area/associated surgical clip seen on prior ultrasound examinations (as this was described in the left breast 9:00 position), nor does this area of enhancement appear to contain macroscopic fat on MRI. No additional abnormal enhancing lesions are identified within the remaining subcutaneous tissues of the breasts.No abnormal axillary lymph nodes are identified in either axillary region.
(1) Indeterminate enhancing lesion within the left breast at the 10:00 position. Prior ultrasound described an area of fat necrosis with associated surgical clip in the 9:00 position, however, this mass is located in the 10:00 position and appears to be separate from the surgical clip. An MR-directed ultrasound is recommended for further evaluation and management. (2) No MRI evidence of malignancy in the right reconstructed breast. BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: E - Additional Mammo/Ultrasound Workup Required.