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Novel Technique for Sampling of Breast Implant–associated Seroma in Anaplastic Large Cell Lymphoma

van Dorp, Martijn MD*; T’Kindt, Johan MD; Mertens, Marianne MD*; Colpaert, Steven D. M. MD

Plastic and Reconstructive Surgery – Global Open: April 2016 - Volume 4 - Issue 4 - p e688
doi: 10.1097/GOX.0000000000000647
Ideas and Innovations
Open
SDC
Belgium
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Summary: We describe a novel technique for the sampling of breast implant–associated seroma. Using a blunt-tip lipofilling cannula, we have the freedom of movement to sample all fluid collections and prevent the misfortunes of damaging the implant. Also, we have demonstrated the inability of the Coleman style I lipofilling cannula to perforate a silicone breast implant. This practical and reliable technique will prove to be useful in managing the breast implant–associated seroma, especially with the rising incidence of the anaplastic large cell lymphoma, where the sampling of seroma is mandatory.

From the *Department of Plastic Surgery, Antwerp Hospital Network (ZNA), Antwerp, Belgium; Department of Plastic Surgery, Jessa Hospital, Hasselt, Belgium; and Department of Plastic Surgery, Monica Academic Hospital, Antwerp, Belgium.

Received for publication January 5, 2016; accepted February 1, 2016.

Disclosure: The authors have no financial interest to declare in relation to the content of this article. The Article Processing Charge was paid for by the authors.

Supplemental digital content is available for this article. Clickable URL citations appear in the text.

Martijn van Dorp, MD, Department of Plastic Surgery, ZNA Middelheim, Lindendreef 1 Ward 8D, 2020 Antwerp, Belgium, E-mail: Martijnvandorp@icloud.com

This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially.

Concern has been raised regarding the incidence of the breast implant–associated anaplastic large cell lymphoma (ALCL) over the last years.1,2 Presentation is infrequent, and symptoms can vary; however, a chronic or unexplained seroma occurring more than 1 year after implantation of a textured breast implant should be considered as highly suspect for ALCL. In accordance with the structured expert consultation process,3 seroma fluid needs to be sent for culture, cytology, flow cytometry, and cell bloc. Immunohistochemical analysis by means of a positive CD30 and a negative anaplastic lymphoma kinase-1 staining is considered diagnostic for ALCL. Seroma fluid sampling is commonly performed by ultrasound-guided needle aspiration. The fluid associated with ALCL tends to be cloudy and debris filled; therefore, large-caliber needles are required for adequate sampling. Radiologists are at risk of perforating the underlying breast implant.

We describe our technique for sampling breast implant–associated seroma without using sharp large-caliber needles. After local anesthetic, a stab incision is made for the introduction of a blunt-tip lipofilling cannula (Fig. 1). Hereby, we have the freedom of movement to sample all fluid collections and prevent the misfortunes of damaging the implant. Also, the lipofilling cannula is fine enough to penetrate the capsule and does not perforate an implant. We prefer the round tip 16-G Coleman style I lipofilling cannula by Mentor (Santa Barbara, Calif); however, several cannulas with an atraumatic tip can be obtained for sampling a breast implant–associated seroma. We have successfully tested the inability of the Coleman style I lipofilling cannula to perforate a textured 350-mL silicone anatomical Natrelle (Irvine, Calif) breast implant (See Video, Supplemental Digital Content 1, which demonstrates the inability of the Coleman lipofilling cannula to perforate a silicone breast implant, whereas a 23-G needle rapidly perforates the implant. This video is available in the “Related Videos” section of the Full-Text article on PRSGlobalOpen.com or available at http://links.lww.com/PRSGO/A188).

Fig. 1.

Fig. 1.

Video 1.

Video 1.

Sampling of a breast implant–associated seroma by means of a lipofilling cannula can be perfectly performed under local anesthesia, on an outpatient basis, and ultrasound guidance is optional. The technique is safe and reliable; moreover, it protects the patient against iatrogenic perforation of her implant.

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REFERENCES

1. Brody GS, Deapen D, Taylor CR, et al. Anaplastic large cell lymphoma occurring in women with breast implants: analysis of 173 cases. Plast Reconstr Surg. 2015;135:695–705.
2. Gidengil CA, Predmore Z, Mattke S, et al. Breast implant-associated anaplastic large cell lymphoma: a systematic review. Plast Reconstr Surg. 2015;135:713–720.
3. Kim B, Predmore ZS, Mattke S, et al. Breast implant-associated anaplastic large cell lymphoma: updated results from a structured expert consultation process. Plast Reconstr Surg Glob Open. 2015;3:e296.

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Copyright © 2016 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons. All rights reserved.