Would a seroma show on a mammogram or ultrasound?

Question

I've had smooth implants since 2011. About a week after stopping birth control pills, I discovered what I thought was a cyst in my RT breast. My GYN sent me for a mamo and ultrasound. Mamo normal, ultrasound could not detect anything when I was laying down. The radiologist actually came in the room and performed the ultrasound. When I stood up she felt the "cyst" and said it was a ripple. Just wondering if it might actually be a seroma or if that would have shown on the mamo or ultrasound? Thank you!

Jerome Edelstein, MD · Answer

Hello,Yes, an ultrasound would most likely show a fluid collection in the breast. Sometimes ripples can be felt in the implant shell through thin areas of the breast- especially sides/under the breast. Feeling a ripple is more likely if you lose weight and breasts lose some natural coverage of the implant. If you have any ongoing concerns, see your Plastic Surgeon in person for an exam.All the  best

Martin Jugenburg, MD · Answer

The mammogram would not be useful in the detection of a seroma. Please note that since Seroma is a collection of fluids in the breasts or under the skin, the breast with it would look larger than its counter-part. Nevertheless, an ultrasound would be able to detect fluids and a seroma depending on the thickness of your breast tissue. The radiologist would have detected something other than a ripple if you had seroma. I hope this is reassuring.Remember to maintain regular follow-up with your surgeon to make sure your breasts are healing well without complications.

Luis M. Rios Jr., MD · Answer

I think this is a great question to answer. 
All breast augmentation patients will have either future mammograms or ultrasounds as routine screening on their yearly OBGyn exam. Some patients will need evaluation for breast pain and palpable masses. And some patients will need evaluation after high impact trauma after a car accident. All these scenarios benefit from a different type of exam.
 For the case of a routine yearly exam after the age of 40, a mammogram can still be done to evaluate the breast. It is thought that a mammogram can still see 80-90% of the breast tissue.
For breast pain and a palpable mass, an ultrasound is a good option to rule out a cyst or to evaluate a solid mass for signs of breast cancer. If a cyst is seen, an ultrasound can be used to safely aspirate (remove the fluid with a needle) the cyst. If the mass is solid on ultrasound, a mammogram can be recommended to further evaluate the mass for any signs of malignancy.
In the case of trauma to a gel implant, an MRI is the best method for determining if the implant is ruptured. It is about 90% accurate, but it is the best we have. For the case of a saline implant, the best way to determine rupture is-  time. A ruptured saline implant will either deflate over night or have significant loss of volume in 2 weeks. A slow leak over months can occur, but in my experience is very rare.
Now let's talk specifically about your case. You had palpated a mass on your breasts. Your OBGyn did the correct thing by sending you for a mammogram and an ultrasound. It appears the ultrasound did not show a cyst or a seroma. Again, the ultrasound is probably one of the most specific tests for visualizing a cyst or seroma. It appears the radiologist did not see these findings on the ultrasound. When he examined you, he felt a "wrinkle" from the implant on your chest. All gel implants have some gentle folds and wrinkles. That's what keeps them soft and natural. Thin patients are more likely to feel these wrinkles. It is common for plastic surgeons to have to evaluate patients after mammograms or ultrasounds because folding of the implant was seen. In most of these cases nothing abnormal is seen on physical exam.
My final recommendation is to get a physical exam by a board certified plastic surgeon, and preferably your surgeon if possible. He/she will be able to help you sort through the radiologic exam and physical exam findings.
Again the ultrasound is the best exam for cysts and seromas, so you are on the right track. Close the loop of knowledge by having an exam with a plastic surgeon
Good luck and thanks for sharing your question with everyone!

Nelson Castillo, MD · Answer

Thank you for sharing your question.  Unfortunately the answer to your question is "it depends."  If your breast tissue is not very thick or dense a seroma can certainly be seen on an ultrasound.  The thicker your natural breast tissue the less the ultrasound can "penetrate" to see deeper into your breast.  Hope this helps.

Emily Hu, MD · Answer

A “seroma” is a collection of fluid within the tissue. Typically this will show up on an ultrasound (but not a mammogram). Cysts and masses will also show up well on an ultrasound.  If your radiologist mentioned a “ripple,” she might have thought she was feeling an edge of the breast implant. In areas where your skin/tissue is thinner, it is sometimes easier to feel the edge of the implant – and this can sometimes feel like a “lump”, “mass”, or “cyst.” It is very encouraging that both your mammogram and ultrasound were negative. However, if you still have concerns or questions, I would recommend that you set up a consultation appointment with your previous plastic surgeon, or at least a American Board of Plastic Surgery board-certified plastic surgeon.

Ian MacArthur, MD, FRCSC · Answer

Thanks for your question. An ultrasound would be able to detect a seroma if present. If there is anything palpable (that you can feel) that does not show on mammogram or ultrasound, it is possible that you are feeling the edge of your implant. My suggestion would be to schedule an appointment with your operating plastic surgeon for an in-person clinical exam. All the best.

Matthew H. Steele, MD · Answer

Thank you for your question.  A mammogram would be unlikely to identify a seroma, but an ultrasound is very sensitive for detecting fluid pockets and is often used to assist with drainage of the fluid.  If they did not see anything on the ultrasound, it is unlikely that you have a seroma.  Good luck.

Ven Erella, MD · Answer

Thank you for your question. Usually seroma will show in ultrasound. I would recommend you to see your PS for evaluation.

Carl W. "Rick" Lentz III, MD (retired) · Answer

A mama gram is a great way to evaluate the breast tissue and even the implant, a ultrasound is the best way to evaluate the possibly of a seroma. Since the Radiologist was actually there and they evaluated the ultrasound and your breast, you most likely don't have a seroma. It would be consistent with a ripple in a saline implant to feel some what like a cyst. The best person to evaluate your  breast would be your original Plastic Surgeon.

Would a seroma show on a mammogram or ultrasound?

Answers (9)

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