Should a Seroma or Hematoma Be Drained Prior to Breast Explantation or Just Drain It During Explantation?

PS believes there may be fluid in breast capsular contracture & wants a mammogram performed. Then possibly a sonogram & MRI. I do not want to wait weeks to find out if there is fluid. Noticeably disfigured & painful.. A 2nd doctor I saw did not mention fluid, just surgery. I want to have implants out asap w/ a lift. If I had surgery & a seroma or hematoma was found, wouldn't they just drain it then? Isn't fluid common w/ explanation? Does the DR. need to know if fluid prior to surgery?

Doctor Answers 4

Breast Augmentation

Fluid collections around an implant can have different causes, bleeding being one.  The approach to removal would involve draining the fluid at the same time, but some work up or tests preop can help plan the surgery.  This is best decided when you have had a board certified plastic surgeon examine you and plan a surgical strategy.  Doing a lift at the same time is a judgement call as it depends on the source of the fluid and whether or not further surgery is a gook idea at the same time.  Find a surgeon you are comfortable with and try to decide on the best course of action based on consultation and mutual decisions.  I hope this informaiton is helpful.-

Chicago Plastic Surgeon
5.0 out of 5 stars 2 reviews

Fluid around the implant

Why question your very thoughtful and caring doctor? he /she is very concerned about your safety! he/she has examine you, and has some concern and recommendations, trust your caring docror.

Samir Shureih, MD
Baltimore Plastic Surgeon
4.2 out of 5 stars 7 reviews

Should a Seroma or Hematoma Be Drained Prior to Breast Explantation

Although I am not certain of the rationale for your surgeon's recommendation, one possibility is a concern for the possible presence of anaplastic large cell lymphoma (ALCL) which is quite rare, and sometimes presents as fluid in the wall of a capsule around the breast implant. Curative treatment is a complete capsulectomy, which otherwise might not necessarily be done. 

If there is no fluid, this would not be a concern. If you choose to go the rout of mammogram, you should be able to schedule one promptly, and proceed based on the finding. An ultrasound would probably be the best first test to look for fluid.

All the best.

Jourdan Gottlieb, MD
Seattle Plastic Surgeon
4.6 out of 5 stars 45 reviews

Concerns Before Revisionary Breast Surgery?

Probably not wise for online consultants to try to second-guess what  rationale a colleague has  for specific preoperative testing. In other words, your plastic surgeon may know more about your situation and/or have specific concerns that online consultants cannot be privy to. Therefore, for an accurate response, best to run this question by your plastic surgeon.

 Having said that, if the imaging is ordered to rule out a fluid accumulation ( and there are no concerns otherwise), then the preoperative imaging is probably unnecessary given that surgery is planned nevertheless,  And the fluid can be trained at that time. If the concern is about the possibility of a rare lymphoma, then a preoperative diagnosis would be helpful.

 Your desire to proceed to the operating room is understandable given the symptoms you are having;  don't hesitate to ask your chosen plastic surgeon about his rationale behind waiting and ordering imaging studies.

 Best wishes for safe/successful revisionary breast surgery.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,487 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.