A lipogranuloma of the female breast is a relatively rare condition. Lipogranulomas are nonallergic foreign body reactions typically found in areas where lipid material has been injected either traumatically or for a specific purpose.2
Several types of lipogranulomas have been reported to develop after injection of lipid substances for cosmetic purposes and after trauma or specific therapy.1,2,6,7
In the breast, this type of soft tissue reaction has been reported. Lipogranulomas can develop after release of a silicone gel from breast implants and after phenothiazine therapy.2,8
Our patient had undergone oriental medicine alternative therapy called "Bu-Hwang" to reduce pain and bruising. "Bu-Hwang" is a traditional oriental alternative medicine therapy and is performed by puncturing the skin and depleting the blood by giving strong negative pressure using a Bu-Hwang cup. According to the tradition, it is considered to facilitate gas exchange for achievement of blood purification. We think that this procedure can draw parenchymal soft tissue or fat tissue into the subcutaneous level. A lipogranuloma is known as iatrogenically caused inflammatory change that occurs mostly in the penis and scrotum of a young adult male.1
Our patient denied having a history of exogenous foreign body injection or topical use of drugs. In this case, we suspect that the lipogranuloma originated from endogenous fat degeneration by the strong negative pressure that pulled the parenchymal fat into the subcutaneous layer. It is known that trauma is related directly to or by an allergic mechanism for the development of a lipogranuloma.6
It seems that "Bu-Hwang" can occasionally be a type of traumatic process.
In our case, the final pathological diagnosis was related to osseous metaplasia. The terms "osseous metaplasia" or "heterotopic bone formation" are used to express bone formation in abnormal locations.4
Osseous metaplasia may develop after trauma, or with a post-traumatic hematoma and soft-tissue tumors, especially slow growing tumors treated with radiation.3
Several cases of osseous metaplasia have been reported that were related to conditions, including tubular adenoma of the colon, diffuse large B-cell lymphoma and amyloid-producing dyscrasia.5,9
Few studies have reported benign breast lesions that were seen as osseous metaplasia.10
It is generally agreed that bone in breast tissue occurs in a variety of mammary lesions and may have more than one mechanism of formation.3
Mammography of nonneoplastic osseous metaplasia of the breast has been reported only once, depicting extensive focal ossification of both breasts in association with chronic nonspecific mastitis.10
Imaging findings of osseous metaplasia for a neoplasm depend on the nature of the underlying neoplasm. In the case of a fibroadenoma or cystsarcoma phylloides, mammography and sonography demonstrate a well-defined, oval lesion with coarse calcification.3
Our case also showed well-defined dense ossification, however, the bizarre shape in this case might have been produced by artificial external pressure due to the "Bu-Hwang" procedure. It is difficult to determine if osseous metaplasia developed from a tumorous condition such as a lipogranuloma or originated from a traumatic process. The suggested mechanism for the origin of osseous metaplasia remains obscure. In this case, post-traumatic fat degeneration after "Bu-Hwang" oriental medicine alternative therapy caused the formation of the lipogranuloma and osseous metaplasia. To the our knowledge, this is the first report of a lipogranuloma with osseous metaplasia on the breast.