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Managing Late Periprosthetic Fluid Collections (Seroma) in Patients with Breast Implants: A Consensus Panel Recommendation and Review of the Literature

Bengtson, Bradley M.D.; Brody, Garry S. M.D.; Brown, Mitchell H. M.D.; Glicksman, Caroline M.D.; Hammond, Dennis M.D.; Kaplan, Hilton M.D., Ph.D.; Maxwell, G. Patrick M.D.; Oefelein, Michael G. M.D.; Reisman, Neal R. M.D., J.D.; Spear, Scott L. M.D.; Jewell, Mark L. M.D.Late Periprosthetic Fluid Collection after Breast Implant Working Group

Plastic and Reconstructive Surgery: July 2011 - Volume 128 - Issue 1 - p 1-7
doi: 10.1097/PRS.0b013e318217fdb0
Breast: Original Article

Background: The goal of this consensus is to establish an algorithm for the management of patients who develop a late or delayed periprosthetic fluid collection. A work group of practicing plastic surgeons and device industry physicians met periodically by teleconference and discussed issues pertinent to the diagnosis and management of late periprosthetic fluid collections in patients with breast implants. Based on these meetings, treatment recommendations and a treatment algorithm were prepared in association with an editorial assistant.

Method: The work group participants discussed optimal care approaches developed in their private practices and from evidence in the literature.

Results: The consensus algorithm and treatment and management recommendations represent the consensus of the group.

Conclusions: The group concluded that late periprosthetic fluid collection (arbitrarily defined as occurring ≥1 year after implant) is an infrequently reported occurrence (0.1 percent) after breast implant surgery and that, at a minimum, management should include clinically indicated ultrasound-guided aspiration of fluid, with appropriate cultures and cytologic testing. Further evaluation and additional treatment is recommended for recurrence of periprosthetic fluid collection after aspiration, or clinical suspicion of infection or neoplasia.

Grand Rapids, Mich.; Los Angeles, Goleta, and Irvine, Calif.; Toronto, Ontario, Canada; Sea Girt, N.J.; South Nashville, Tenn.; Houston, Texas; Washington, D.C., and Eugene, Ore.

From the Bengtson Center for Aesthetics and Plastic Surgery; the Division of Plastic Surgery, Keck School of Medicine, University of Southern California; private practice; the Center for Breast and Body Contouring; Allergan Medical; Maxwell Aesthetics; Allergan, Inc.; Baylor College of Medicine; Georgetown University Hospital; and Jewell Plastic Surgery Center.

Received for publication December 3, 2010; accepted February 15, 2011.

Disclosure: Dr. Bengtson is a consultant for Allergan, Inc., and LifeCell Corporation; is a recipient of an Aesthetic Surgery Education and Research Foundation grant for high-resolution ultrasound research; and is an investigator in the Adjunct and Allergan 410 implant clinical studies. Drs. Brody and Reisman report no conflicts of interest. Drs. Brown and Spear are both consultants for Allergan and LifeCell. Drs. Glicksman and Maxwell are both consultants and investigators for Allergan. Dr. Hammond is a consultant for Mentor, LLC, and Allergan. Dr. Jewell is a consultant for Allergan, an approved clinical investigator for Mentor and Allergan, and an assistant clinical professor of plastic surgery at Oregon Health Science University, Portland, Oregon. Drs. Oefelein and Kaplan are both employees of Allergan. Allergan's involvement in this study was limited to the participation of Drs. Kaplan and Oefelein, as authors. Allergan funded the editorial support of manuscript development.

The views, opinions, and techniques set forth in this article addressing anaplastic large cell lymphoma in women with breast implants are those of the individual author(s) and do not reflect the views, opinions, or recommendations of the American Society of Plastic Surgeons, the Journal or the Journal editors. Any treatment recommendations contained in the article are those of the individual author(s) and are not to be considered or construed as practice guidelines, practice standards, or practice parameters. The use of any treatment technique described in the article is at the sole discretion of the physician in the exercise of his or her independent medical judgment taking into account the patient's individual circumstances.

Mark L. Jewell, M.D., Jewell Plastic Surgery Center, 10 Coburg Road, Suite 300, Eugene, Ore. 97401,

©2011American Society of Plastic Surgeons