I have had textured saline implants for 15 years. Recently had left breast suddenly swell and become hard. Surgeon scheduled operation for capsular contraction but upon surgery found > 200 cc of fluid and no contraction. No signs of infection or blood in lab results of fluid. The breast has again filled with fluid and my surgeon is unsure why this has happened. I haven't suffered any trauma to breast. Would appreciate help in understanding why this is happening
Seroma in 15-year-old Breast Implants?
Doctor Answers 8
Sudden seroma in 15 year old Textured surface breast Implants.
I fully agree with Dr. Reath and wish to add a few comments.
In my opinion ANY late sudden seroma with either normally "behaving" smooth or textured breast implants should be considered to be an infection REGARDLESS of the cultures obtained at surgery. It is NOT uncommon for women to seed (infection spear from another area) implants after urinary tract infection, dental cleaning or gum surgery. Anytime bacteria enter the blood steam, they can reach and attach themselves to the wall of an implant (breast, joint, shunt etc)where they form a film which cannot be removed by our body's defense mechanism. Pre-treating with Penicillin V just before dental cleaning is rather cheap and could prevent secondary implant infection and or capsular contracture.
Very commonly cultures obtained during surgery are negative. This does NOT mean that you did not have an infection. it only means that whatever was there did not grow in the culture tube. Sometimes the antibiotics given just prior to surgery temporarily drop the number of live bacteria giving a false negative. In other cases, the bacteria are so called ATYPICAL and while they live well in us do not live and multiply on common culture media and special culture techniques may find them. so - negative culture means no growth - not no bacteria.
There are few benefits to using textured implants in cosmetic breast surgery. the only benefit being the use of anatomic / tear drop shaped implants. Owing to the texturing once they become infected such implants uniformly need to be exchanged.
Hope this helps.
Dr. P. Aldea
Seroma 15 years after breast augmentation
I would echo the concerns of my colleagues...
I would delay any reinsertion of implants for at least 6 months.
Implants and a later seroma
It sounds like you could have an infection of some sort. I would remove the implants and capsule and get fungal cultures. You may consider delaying putting back in new implants.
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Late seroma with texture implants.
Your occurence of a late seroma in the presence of a texture implant is a bit of a concern. You surgeon should biopsy the capsule around the implant and send the seroma fluid off for analysis. In a very few cases there can be a build up of lymphocytes in the capsule that can usually can be treated by removal of your capsule. Dr. Garry Body at the University of Southern California Keck School of Medicine has been looking into this. You plastic surgeon may wish to contact him.
Seroma in old implants
I can't say I know why this happens but I myself have seen it on a rare occasion. If the implants are over the muscle I would recommend a capsulectomy and reaugmentation in the sub muscular position. I am not a big fan of textured implants except when they are shaped or biodimensional implants. I use a drain for anywhere from 3-5 days and sometimes longer. Unfortunately I can't tell you why it does occur in some patients but it is very unusual.
Seroma in 15-year-old Breast Implants?
in addition to studies for infection, recent concerns raised by the FDA suggest that the fluid should also be submitted for histology to rule out ALCL.
Late seroma following breast augmentation
Infection and tumor are two important things to rule out in this situation. Diagnosing infection can be difficult, as some organisms only grow slowly, and under special conditions. Special testing for atypical mycobacteria should be included in your investigations.
Tumors or inflammatory conditions will be diagnosed based on the specimen (fluid and tissue) that is sent from surgery for review by the Pathologists. If these weren't sent initially, they should be sent at your next procedure.
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