Breast asymmetry due to delayed seroma formation on the right 4 years following breast augmentation

The development of a fluid collection (known as a seroma) after breast surgery with implants (either breast augmentation or breast reconstruction) is a well established potential complication. Historically, most fluid collections will develop within the first few weeks or months of an operation. This can manifest as an increase in the  size of the affected breast. However, delayed fluid collections that occur more than a year after an operation (also known as  “late peri-prosthetic fluid collections“) are exceedingly uncommon,  likely under-reported, and thought to occur in less than one percent of all cases.

Patients who develop delayed fluid collections may present with:

1) Breast swelling

2) Breast assymmetry

3) Breast tenderness

4) +/- Palpable fluid collection around the implant

Causes of delayed fluid collections may include:

1) Vascular or lymphatic leaks

2) Inflammation following a bacterial infection, trauma or hematoma

3) Lymphoproliferative disorders or anaplastic large T-cell lymphoma

4) Synovial metaplasia (capsule cell abnormality) from mechanical sheer forces between the implant & capsule

5) Breast Implant Rupture

6) Idiopathic (unknown cause)

A recent Consensus Panel report looked at the recommendations for the best way to treat this small subset of breast implant patients (Bengtson, et al., Late Periprosthetic Fluid Collection after Breast Implant Working Group, PRS 128, #1, July 2011, p1).  The two most important first steps are to rule out any infectious causes, and then rule out any oncologic causes (i.e breast cancers, ALCL, etc.). Once these two causes have been ruled out, then the appropriate treatment regimen follows a surgical approach and includes:

1) Removing the existing implants

2) Removing the surrounding breast capsules

3) Pulse Irrigation of the breast pockets, followed by irrigation with antibiotic solution

4) Possible re-implantation (with new implants)

5) Closed-suction drain placement and post-operative antibiotics.

*photos on this post are of an actual pre-operative patient of Dr. Brenner.

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