43-year-old female with history of right breast cancer status post mastectomy and chemotherapy as well as prophylactic left mastectomy presenting for unilateral left breast ultrasound for increasing left breast nodularity, specifically new nodularity inferior and medial to the nipple and near the left upper outer quadrant. Patient has bilateral breast implants. Family history of breast cancer in maternal grandmother diagnosed in her 40s. On physical examination, there is superficial small somewhat firm subcentimeter masses in the 7:00 and 8:00 position overlying the breast implant. On palpation of the left upper outer quadrant there is dense tissue with no discrete mass palpated. A targeted left ultrasound was performed for the palpable area of concern. The breast implant is visualized. In the left breast 7:00 position 2 cm from the nipple superificial to the implant is an oval circumscribed parallel hypoechoic mass with areas of internal hyperechogenicity measuring 0.5 cm x 0.2 cm x 0.3 cm with no internal vascularity on Doppler imaging. Adjacent to this mass in the left breast 8:00 position 2 cm from the nipple is a similar morphology mass measuring 0.5 cm x 0.1 cm x 0.4 cm with no internal vascularity on Doppler imaging. In the left breast 1:00 position 6 cm from the nipple there is dense breast tissue overlying the implant with no solid or cystic mass identified.
No sonographic evidence for malignancy. Two likely benign morphology masses in the left breast 7:00 and 8:00 position are most compatible with fat necrosis. Per discussion with patient, she would like to proceed with ultrasound-guided biopsy of one of these lesions to confirm benignity, and she declined short term follow up as a management option. BIRADS: 3 - Probably benign finding.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration.