Achieving Reliable Diagnosis in Late Breast Implant Seromas (original) (raw)
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A Clinical Study of Late Seroma in Breast Implantation Surgery
Aesthetic Plastic Surgery, 2012
Background The use of mammary implants may lead to a variety of early and delayed complications. The most common delayed complications are capsular contracture and implant failure. Late seroma has seldom been reported. In a long-term prospective observational study, cases of late seroma were assessed and recorded. Methods Between March 2005 and November 2009, suspected cases of late seroma in patients who had undergone breast augmentation or reconstruction with textured implants were evaluated clinically and with instrumental analyses. An ultrasound-guided needle aspiration of the fluid was performed. Results In this study, 13 cases of late seroma (8 augmentations and 5 reconstructions) were observed. The overall incidence of this complication was 1.68%. Chemical analyses confirmed the diagnosis of seroma, which recurred in all the patients within days of evacuation. For 12 patients, a reoperation was performed, during which the implant was removed, a total capsulectomy was performed, and in cases of subglandular breast augmentation, the implant pocket was changed to a submuscular placement before a new prosthesis was inserted. One patient underwent a second ultrasound-guided needle aspiration. No seroma recurrence was observed in any of the patients during the follow-up period.
Late Seromas after Breast Implants
Plastic and Reconstructive Surgery, 2012
Background: Late seromas surrounding breast implants are becoming an increasingly important issue in breast surgery. The authors report their experience with late seromas and describe their previous management options. Methods: A multicenter retrospective review of patients who developed late seromas (clinically presenting seromas without evidence of overt or documented infection more than 1 year after implant operation) was performed. Management, surgical technique, outcomes, complications, culture findings, and cytology results were recorded. Results: Between 2005 and 2010, 28 late seromas were identified in 25 patients. The average interval from the patient's last surgery to seroma onset was 4.7 years; 27 of 28 breasts (96 percent) had a Biocell textured device in place at the time of seroma development. The late seromas in the series were managed as follows: 15 (53.6 percent) by complete capsulectomy, seroma drainage, and new implant placement; three (10.7 percent) by seroma drainage and new implant placement but without capsulectomy; two (7.1 percent) by complete capsulectomy and seroma drainage but without implant replacement; five (17.9 percent) by only ultrasound-guided seroma drainage without the need for surgical intervention; and three (10.7 percent) by antibiotic therapy alone. All cultures and cytology studies were negative for malignancy or infection; 27 of 28 seromas (96 percent) were treated successfully by one of the described approaches. Conclusions: Biocell textured implants were more likely to be associated with late seromas than were smooth shell implants. The overwhelming majority of late seromas appear to be idiopathic, without clear evidence of infection or malignancy. A graduated approach, including several different management strategies, was used to successfully manage these patients.
European Journal of Plastic Surgery, 2014
Silicone gel-filled breast implants are the backbone of augmentation mammoplasty. Although a safe and straightforward procedure, augmentation mammoplasty is not exempted from complications. Seroma formation-as a well-known complication-generally occurs at early postoperative period. Although it generally undergoes spontaneous resorption within four to six postoperative weeks, its persistence can cause increased pain, wound dehiscence and infection, which might necessitate subsequent removal of the implant. The term "late seroma" describes seroma after 4 months postoperatively. Late seromas are rare and tend to occur unilaterally. Although late seromas generally have an insidious onset, clinical presentation may vary regarding each individual patient. We present a case report of extensive late seroma formations, with sudden onset, on both sides in a consecutive manner. Our review of the literature suggests that this is the only report of consecutive late seroma formation on both sides of a silicone gel breast augmentation patient. Level of Evidence: Level V, diagnostic study.
Aesthetic Plastic Surgery, 2011
Any complication after breast augmentation can raise fear and concern in the patient. It can project the lack of an expected or desired result because a complication could eventually lead to the temporary or permanent removal of the implant. Although a complication can be considered a professional failure, it provides opportunity for further investigation exploring the reasons, establishing adequate treatment,
PLOS ONE, 2017
Late breast implant seroma may be the presentation of a breast implant-associated anaplastic large cell lymphoma (BI-ALCL), which claims for a prompt recognition. However, BI-ALCL diagnosis on fine-needle aspiration (FNA) might be challenging for pathologists lacking experience with peri-implant breast effusions. Sixty-seven late breast implant seromas collected by FNA from 50 patients were evaluated by Papanicolaou smear stain and immunocytochemistry on cell blocks. A diagnostic algorithm based on the cellular composition, cell morphology and percentage of CD30 + cells was developed. Histological evaluation of the corresponding peri-prosthetic capsules was also performed. Most of the effusions (91% of the samples) were classified as reactive and 9% as BI-ALCL. In the BI-ALCL cases, medium-to-large atypical cells expressing CD30 represented more than 70% of the cellularity, whereas in in the reactive effusions CD30 + elements were extremely rare (<5%) and consisted of non-atypical elements. The reactive effusions were categorized into three patterns: i) acute infiltrate with prominent neutrophilic component (33% of the samples); ii) mixed infiltrate characterized by a variable number of neutrophils, lymphocytes and macrophages (30% of the samples); iii) chronic infiltrate composed predominantly of T lymphocytes or macrophages with only sporadic granulocytes (37% of the samples). The inflammatory cytological patterns were consistent with the histology of the corresponding capsules. Our results indicate that cytological analysis of late breast implant effusions, supported by the knowledge of the heterogeneous cytomorphological spectrum of late seromas, is a valuable approach for the early recognition of BI-ALCL.
Incidence of Clinically Significant Seroma after Breast and Axillary Surgery
Journal of the American College of Surgeons, 2009
Seroma is a collection of serous fluid that occurs at rates ranging from 3% to 85% after breast or axillary surgery. 1,2 Varying methods of defining seroma likely account for the wide variation in rates of incidence reported in the literature. Seromas can interfere with healing, require prolonged treatment, cause patient discomfort, and delay adjuvant treatment. We hypothesized that seromas occur more frequently in extensive surgical procedures or in those that require a drainage tube. In addition, we theorized that seroma and surgical site infection (SSI) were directly correlated. The aims of this study were to evaluate the frequency of seromas that require intervention, to assess variation based on the extent of the breast or axillary surgical procedure, and to evaluate the incidence of SSI in relation to seroma occurrence.
The relation between seroma fluid and local recurrence after conservative breast surgery
Ain Shams Journal of Surgery, 2014
Objectives: After conservative management of breast cancer, two third are at risk of local relapse, a risk which is largely reduced by radiotherapy. Seroma formation after mastectomy typically delays recovery and adds to morbidity. Aim of the work: This study aims at collection of the seroma fluid after conservative breast surgery and detection of malignant cells in the drained fluid and its relation with local recurrence. Methods: Twenty three patients with early breast cancer were included in the study and after conservative breast surgery. Seroma fluids were collected from the drain for detection of malignant cells then these patients were followed for twelve to twenty four months for detection of local recurrence Results: There was a high significance in local recurrence associated with cases showing malignant second samples compared with those with negative one (X 2 =29.076, p=0.000). Conclusions: Persistent presence of malignant cells in the postoperative drained fluid in females with early breast cancer is predictive for local recurrence. However long terms follow up and an increase in the number of the studied cases is recommended to confirm these results.
International Journal of Radiation Oncology Biology Physics, 2008
Purpose: To evaluate the effect of the time from surgery and other clinical factors on seroma volume and clarity and establish the optimal time to use the computed tomography (CT)-based seroma to plan partial breast irradiation (PBI). Methods and Materials: A total of 205 women with early-stage breast cancer underwent planning CT after breastconserving surgery. One radiation oncologist contoured the seroma volume and scored the seroma clarity, using a standardized Seroma Clarity Score scale, from 0 (not detectable) to 5 (clearest). Univariate and multivariate analyses were performed to evaluate the associations between the seroma characteristics and the interval from surgery and other clinical factors. Results: The mean interval from surgery to CT was 84 days (standard deviation 59). During postoperative Weeks 3-8, the mean seroma volume decreased from 47 to 30 cm 3 , stabilized during Weeks 9-14 (mean 21) and was involuted beyond 14 weeks (mean 9 cm 3 ). The mean seroma clarity score was 3.4 at Weeks 3-8, 2.5 at Weeks 9-14, and 1.6 after 14 weeks. The seroma clarity was greater in patients aged $70 years. The seroma volume and clarity correlated significantly with the volume of excised breast tissue but not with the maximal tumor diameter, surgical re-excision, or chemotherapy use. Conclusion: The optimal time to obtain the planning CT scan for PBI is within 8 weeks after surgery. During Weeks 9-14, the seroma might remain adequately defined in some patients; however, after 14 weeks, alternate strategies are needed to identify the PBI target. The lack of correlation between the seroma volume and tumor size suggests that the CT-based seroma should not be the sole guide for PBI target volume definition. Ó 2008 Elsevier Inc.