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Case number:	167
Age:	63
Clinical presentation:	Postmenopausal woman who had undergone breast-conserving surgery in 2003 for right breast cancer presented for regular surveillance check-up. On clinical examination, a firm nodularity was noted at the scar site in the right breast.

Mammography:

Breast composition:	ACR category a (the breasts are almost entirely fatty)
Mammography features:
‣ Location of the lesion:	2012: Right breast, upper outer quadrant at 12 o’clock, posterior third, beneath surgical scar
‣ Mass:
• Number:	1
• Size:
• Shape:	Irregular
• Margins:	Spiculated
• Density:	Equal
‣ Calcifications:
• Typically benign:	None
• Suspicious:	None
• Distribution:	None
‣ Architectural distortion:	Present
‣ Asymmetry:	None
‣ Intramammary node:	None
‣ Skin lesion:	None
‣ Solitary dilated duct:	None
‣ Associated features:	Scar tissue with skin thickening

Mammography features:
‣ Location of the lesion:	2017: Right breast, upper outer quadrant at 12 o’clock, posterior third, beneath surgical scar
‣ Mass:
• Number:	1
• Size:
• Shape:	Irregular
• Margins:	Spiculated
• Density:	Equal
‣ Calcifications:
• Typically benign:	Fat necrosis calcifications
• Suspicious:	None
• Distribution:	None
‣ Architectural distortion:	Minimal
‣ Asymmetry:	None
‣ Intramammary node:	None
‣ Skin lesion:	None
‣ Solitary dilated duct:	None
‣ Associated features:	Scar tissue with skin thickening

Mammography features:
‣ Location of the lesion:	2018: Right breast, upper outer quadrant at 12 o’clock, posterior third, beneath surgical scar
‣ Mass:
• Number:	1
• Size:
• Shape:	Irregular
• Margins:	Spiculated
• Density:	Equal
‣ Calcifications:
• Typically benign:	Round, fat necrosis calcifications
• Suspicious:	None
• Distribution:	None
‣ Architectural distortion:	Minimal
‣ Asymmetry:	None
‣ Intramammary node:	None
‣ Skin lesion:	None
‣ Solitary dilated duct:	None
‣ Associated features:	Organized scar with fat necrosis calcifications

Ultrasound:

Ultrasound features: 2018: Right breast, upper quadrants at 12 o'clock
‣ Mass
• Location:	2018: Right breast, upper quadrants at 12 o'clock
• Number:	None
• Size:	None
• Shape:	Irregular
• Orientation:	Not parallel
• Margins:	Angular
• Echo pattern:	Hypoechoic
• Posterior features:	Strong posterior shadowing
‣ Calcifications:	Surgical scar macrocalcification
‣ Associated features:	Architectural distortion
‣ Special cases:	None

BI-RADS:

BI-RADS Category (Right BCS, post operative breast): 2 (benign)

Case summary:

Postmenopausal woman who underwent breast-conserving surgery in 2003 for right breast carcinoma presented with firm nodularity along the scar tissue. Diagnosed as organized scar with typically benign calcifications at surgical site, BI-RADS 2 on imaging.

Learning points:

In patients on annual surveillance after breast-conserving surgery, mammography is challenging because the normal breast architecture is altered after surgery. The surgical scar usually decreases in density and/or size on serial imaging as is seen in this case. However, an increase in size or density on serial mammogram is suspicious for recurrence.