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Late Seromas after Breast Implants: Theory and Practice

Spear, Scott L. M.D.; Rottman, Steven J. M.D.; Glicksman, Caroline M.D.; Brown, Mitchell M.D.; Al-Attar, Ali M.D., Ph.D.

Plastic & Reconstructive Surgery: August 2012 - Volume 130 - Issue 2 - p 423–435
doi: 10.1097/PRS.0b013e3182589ea9
Cosmetic: Original Articles
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Expert

Background: Late seromas surrounding breast implants are becoming an increasingly important issue in breast surgery. The authors report their experience with late seromas and describe their previous management options.

Methods: A multicenter retrospective review of patients who developed late seromas (clinically presenting seromas without evidence of overt or documented infection more than 1 year after implant operation) was performed. Management, surgical technique, outcomes, complications, culture findings, and cytology results were recorded.

Results: Between 2005 and 2010, 28 late seromas were identified in 25 patients. The average interval from the patient's last surgery to seroma onset was 4.7 years; 27 of 28 breasts (96 percent) had a Biocell textured device in place at the time of seroma development. The late seromas in the series were managed as follows: 15 (53.6 percent) by complete capsulectomy, seroma drainage, and new implant placement; three (10.7 percent) by seroma drainage and new implant placement but without capsulectomy; two (7.1 percent) by complete capsulectomy and seroma drainage but without implant replacement; five (17.9 percent) by only ultrasound-guided seroma drainage without the need for surgical intervention; and three (10.7 percent) by antibiotic therapy alone. All cultures and cytology studies were negative for malignancy or infection; 27 of 28 seromas (96 percent) were treated successfully by one of the described approaches.

Conclusions: Biocell textured implants were more likely to be associated with late seromas than were smooth shell implants. The overwhelming majority of late seromas appear to be idiopathic, without clear evidence of infection or malignancy. A graduated approach, including several different management strategies, was used to successfully manage these patients.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Washington, D.C.; Sea Girt, N.J.; and Toronto, Ontario, Canada

From the Department of Plastic Surgery, Georgetown University Hospital; private practice; and the Division of Plastic and Reconstructive Surgery, University of Toronto.

Received for publication August 3, 2011; accepted February 14, 2012.

Disclosure: Drs. Spear and Brown are paid consultants for LifeCell (Branchburg, N.J.) and Allergan (Irvine, Calif.). Dr. Glicksman is a paid consultant for Allergan. Drs. Rottman and Al-Attar have no financial interests in any of the products or devices mentioned in this article. This study was not supported by any external funding.

Scott L. Spear, M.D.; Georgetown University Hospital, 3800 Reservoir Road, NW, PHC Building, 1st Floor, Washington, D.C. 20007, spears@gunet.georgetown.edu

©2012American Society of Plastic Surgeons