Late Onset (10 Yrs Post Breast Augmentation) Seroma Without Bothersome Symptoms, is Seroma Aspiration Necessary?

MRI showed a R sided intracapsular seroma (measures 1.6 cm in maximal thickness) surrounding the R silicone implant; with no specific imaging features of infection. I am not having symptoms; Gen surgeon recommended an aspiration retropectoral seroma. If the seroma is not really bothering me, do I need to get it aspirated or can I just leave it alone? If left alone, what are the risks? I was planning to leave it alone and in about 1 yr have my silicone implants replaced with a bit larger size.

Doctor Answers 3

Late Breast Implant Seroma Needs To Be Evaluated

This atypical but asymptomatic breast implant seroma should not be ignored. It is important to rule out the occurrence of ALCL, a very rare form of cancer. It should be aspirated and the fluid evaluated, or even better, have an open evaluation of the implant capsule and fluid pocket with a biopsy.

Late Onset or Persistent Breast Seroma Following Breast Augmentation Should be Evaluated For ALCL

There is some evidence to suggest there may be a rare association of anaplastic large cell lymphoma (ALCL; a form of non-Hodgkin’s lymphoma) and breast implants. ALCL is a rare disease by itself, and those occurring in the breast are even rarer. Perhaps 30+ cases have been reported in the world literature over the past 25 or more years, but the specific information of each case has not been well-reported and is incomplete to draw any definitive conclusions.

ALCL can occur anywhere in the body, but ALCL that has occurred in association with breast implants is frequently found in the capsule surrounding the breast implant. Many of the women (with breast implants), who have been diagnosed with ALCL, have presented with a seroma surrounding the implant.

A seroma that forms around a breast implant should therefore not be ignored; this seroma should undergo diagnostic evaluation. It is recommended that a seroma which occurs six or more months after implantation should be evaluated by aspiration and cytologic examination. Recurrent seromas should be evaluated this same way as well.

If a diagnosis of implant-associated ALCL is made, a full medical evaluation should be performed to rule out the presence of systemic disease. The treatment of ALCL confined to the breast (capsule) should consist of removal of the involved capsule and implant. This appears to treat the disease and prevent recurrence. Additional adjuvant radiation or chemotherapy does not appear to be necessary for ALCL localized to the capsule.

There is uncertainty about the risk of ALCL recurrence or progression if immediate re-implantation is performed at the time of implant and capsule removal. ALCL that occurs in women with breast implants does not have to be associated with a breast mass/lump. ALCL can occur in association with saline or silicone breast implants, smooth or textured implant surfaces, and subglandular or submuscular placement.

A registry for reporting these ALCL cases has now been established, so moving forward we will be able to gather more detailed information that will hopefully provide better understanding of this disease.

Kenneth Dembny, II, MD
Milwaukee Plastic Surgeon
4.9 out of 5 stars 34 reviews

Seroma after breast augmentation

Dear Barb Silva.  Late seromas are typically benign, but aspiration is advised to rule out the possibility of a rare form of cancer called "anaplastic large cell lymphoma".  I would recommend you proceed with your general surgeon's recommendation (or see a plastic surgeon).   

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