50-year-old woman BRCA1 mutation carrier with history of bilateral mastectomy presents for further evaluation of a palpable abnormality left reconstructed breast. On physical exam, there is a solid palpable mobile mass in the left breast 1:00 position approximately 5 cm from nipple, at the site of clinical concern.A targeted left grayscale and color Doppler ultrasound was performed for the palpable area of concern. In the left breast 1:00 position 5 cm from the nipple, there is an oval mixed echogenicity mass measuring 1.7 x 1.3 x 1.3 cm with posterior acoustic shadowing, indeterminate. No internal vascularity. Histological sampling is recommended for further evaluation.
Corresponding to the palpable abnormality in the left reconstructed breast is an indeterminate mass measuring up to 1.7 cm. Percutaneous tissue sampling is recommended. Differential considerations include fat necrosis and malignancy. The findings and recommendation were discussed with the patient at the time of the exam. If clinically needed, the mass would be amenable to ultrasound guided biopsy. BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: T - Take Appropriate Action - No Letter.