Late Seroma Research Articles

Breast implant-associated anaplastic large cell lymphoma in Romania: First case series of all documented cases

SummaryBreast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is an uncommon malignancy linked to textured breast implants by moderate evidence in 2021. Documenting Romanian cases provides valuable insights into epidemiology, management, and outcomes, enhancing global understanding and informing clinical practices. Our objectives were to analyze BIA-ALCL cases in Romania, focusing on patient demographics, implant characteristics, clinical presentation, diagnostic methods, treatment, and outcomes.We conducted a retrospective review of all known BIA-ALCL cases in Romania, examining patient demographics, implant details, clinical presentation, diagnostic methods, and outcomes. Data sources included medical records, surgical reports, follow-up data, and implant characteristics like shape, texture, and manufacturer.The mean age at diagnosis was 44.4 years. All patients had textured implants and no replacements, 4 with aesthetic indication and 1 reconstruction. The mean time from implantation to diagnosis was 7.2 years. Clinical presentations were primarily late seromas, diagnosed through fine needle aspiration and immunohistochemistry. Treatments involved multidisciplinary teams, with bilateral en-bloc explantation and adjuvant therapies in two cases. One patient had immediate reconstruction with smooth implants and Acellular Dermal Matrix. No disease recurrence was observed post-treatment.The low BIA-ALCL prevalence in Romania estimated at 1:44,500 compared to the mean of 1:13,745 in Europe indicates the need for an increased awareness and tracking. Establishing mandatory national implant registries, pathology databases, and enhancing physician and patient education will help identify potential cases. All cases involved textured implants, highlighting the need for ongoing research to identify risk factors and guide surgeons consulting patients with these implants.

Mucormycotic late seroma after Poland syndrome correction with implant-enhanced latissimus dorsi flap – A case report

Introduction. Breast malformation correction with implants is a com-mon procedure, and a potential complication is the development of a late seroma, defined as occurring more than one year post-implan-tation. Etiologies include infectious, auto-inflammatory, and neoplastic factors. This case report presents an unusual case of seroma due to mycosis emerging 15 years after amastia correction using a latissimus dorsi flap (LD) and implants. Materials and methods. In 2006, a 44-year-old patient underwent amastia correction with an LD flap and implants in Ecuador. She pre-sented with sudden breast volume increase, tension, and pain in the left breast. Urgent intervention involved implant removal, collection evacuation, and total capsulectomy. Cytological/histological analysis ruled out neoplasia, while microbiological examination identified Muco-rales as the cause. After an uneventful postoperative period, a definitive breast prosthesis was implanted two years later, following ultrasound evaluation and inflammation indices. Discussion. Mucorales are opportunistic pathogens, particularly in im-munocompromised or uncontrolled diabetes patients, causing infections in sinuses, brain, and lungs. Mucormycosis linked to breast implants in immunocompetent individuals is rare and poorly defined in literature. Conclusions. Late seroma onset post-breast implants is rare, and a prompt differential diagnosis is crucial due to potential malignancies like BIA-ALCL. Mucormycosis, a potentially lethal condition, requires medical and sometimes surgical intervention. The incidental discovery of Mucorales infection facilitated complete eradication of the patholo-gy, resulting in full recovery.

Late seroma complication in a breast augmentation patient with fibrin accumulation: a case report

Breast implant surgery is one of the most commonly performed aesthetic surgery around the world. Late seroma is a well known complication that is linked to breast implant-associated anaplastic large cell lymphoma (BIA-ALCL). However, there are some clinically confounding cases of late seroma that present with BIA-ALCL like symptoms. Here we report a case of a 30-year-old female patient who underwent bilateral breast augmentation that presented with a late seroma case with symptoms matching that of BIA-ALCL–abrupt swelling and pain–that was later diagnosed as abnormal accumulation of fibrin.

BIA-ALCL and BIA-SCC: Updates on Clinical Features and Genetic Mutations for Latest Recommendations

Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) and Breast Implant-Associated Squamous Cell Carcinoma (BIA-SCC) are emerging neoplastic complications related to breast implants. While BIA-ALCL is often linked to macrotextured implants, current evidence does not suggest an implant-type association for BIA-SCC. Chronic inflammation and genetics have been hypothesized as key pathogenetic players, although for both conditions, the exact mechanisms and specific risks related to breast implants are yet to be established. While the genetic alterations in BIA-SCC are still unknown, JAK-STAT pathway activation has been outlined as a dominant signature of BIA-ALCL. Recent genetic investigation has uncovered various molecular players, including MEK-ERK, PI3K/AKT, CDK4-6, and PDL1. The clinical presentation of BIA-ALCL and BIA-SCC overlaps, including most commonly late seroma and breast swelling, warranting ultrasound and cytological examinations, which are the first recommended steps as part of the diagnostic work-up. While the role of mammography is still limited, MRI and CT-PET are recommended according to the clinical presentation and for disease staging. To date, the mainstay of treatment for BIA-ALCL and BIA-SCC is implant removal with en-bloc capsulectomy. Chemotherapy and radiation therapy have also been used for advanced-stage BIA-ALCL and BIA-SCC. In-depth characterization of the tumor genetics is key for the development of novel therapeutic strategies, especially for advanced stage BIA-ALCL and BIA-SCC, which show a more aggressive course and poor prognosis.

Our Experience in Diagnosing and Treating Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL).

Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is an uncommon T-cell lymphoma detected in association with textured implants. It presents as a fluid accumulation around the implant, usually years after the implantation. We present our experience in diagnosing and treating four patients with BIA-ALCL, each widely differing from the other. Data on patients' surgical history, relevant medical information, and findings on pathological slides were retrieved from their medical charts and retrospectively reviewed. Each of the four patients was diagnosed with BIA-ALCL, one after breast augmentation, one after breast reconstruction with an implant, one after breast reconstruction with a latissimus dorsi flap and implant, and the fourth after the removal of breast implants. The cases were presented to a multidisciplinary team and subsequently underwent surgery. All four are currently free of tumors, as established by a negative follow-up via positron emission tomography-computed tomography. Although the incidence of BIA-ALCL is rare, these cases emphasize the need to rule out the diagnosis of BIA-ALCL in patients with textured implants or a history of implanted textured devices who present with symptoms such as late seroma or peri-implant mass. This pathology is typically indolent and slow-growing and heightened awareness for an early diagnosis could lead to quicker intervention and enhanced patient management.

Latissimus dorsi seroma prevention with running quilting suture using barbed suture

Dorsal seroma is a common complication of autologous latissimus dorsi flap (ALDF) in breast reconstruction, and has limited the use of this technique, despite its aesthetic success. It is important to find a right technique to limit the incidence of seroma formation after ALDF. The aim of this study was to evaluate the effectiveness and tolerance of a dorsal quilting technique called "running quilting" using barbed resorbable suture in seroma prevention. Three hundred patients who underwent ALDF breast reconstruction in the period between 2004 and 2014 were included in this study. The population was divided in 3 groups; without quilting, with simple quilting suture, and with running quilting using barbed suture. The incidence of small seromas (requiring 1 or 2 aspirations during routine postoperative visits without adding additional appointments to the follow-up routine) was not significantly decreased: it was 54% in the non-quilted group, 47% in group 2 Quilting, and 34% in group 3 running quilting. However, quilting reduced the duration of drainage, and the rate of late seromas (from 8% to 0%), and chronic sero-hematomas completely disappeared in our experience. Running quilting using barbed suture is highly effective in preventing late and refractory donor-site seromas. Its effectiveness is expected to increase the use of ALDF in breast reconstruction, which we consider currently as one of the best autologous reconstruction techniques.

OC-119 Specialization is essential: our results in 139 incisional hernia repairs with a high percentage of moderate-to-high complex cases.

Abstract Aims Presenting 139 repairs by 4 specialised surgeons, mostly of moderate/high complexity. Material & Methods Prospective study (EVEREG registry). Results 65 men. 65.49 (35–93) year-old. Middle BMI 30.31 kg/m2 (52%≥30). 96.4% ASA II/III. Hernias: 113 midline, 15 lateral, 11 combined. Mean defects 86.25cm2 (2–480). 29 W3, 92 W2, 4 paraostomal, 34 recurrent. 9 received botulinum toxin. Surgeries: 132 elective. 89.9% open. 30 components separations (21.6%, 23 TAR). 23 (16.5%) received two meshes. Principal mesh position: 55.4% retromuscular, 34.5% preperitoneal, 6.5% intraperitoneal, 3.6% others. Defect closure: 87.1%. Mean overlap 8.3cm (1–23). 61 associated procedures highligthing 18 dermolipectomies, 10 colorectal surgeries, 8 diffuse adhesiolysis, 8 mesh explants (2 infected). Intraoperative complications: 9 patients (6.5%). 8 bowel injuries (5 serosal tears), 1 muscular bleeding, 1 bladder injury. Postoperative complications: 22.3% patients. 21 grade I, 6 II, 3 III, one IV. Highlighting: ileum (9), hematoma/anemia (9), general (6), seroma (4), 4 surgical site infections (SSI, 1 deep, 2 organ/space, 1 superficial), 1 bowel perforation. 4 reinterventions (2.9%), 2 due to visceral complications. No exitus. Mean stay: 4.46 days. 1 month: 36 patients complicated (25.9%); highlighting 21 seromas (76% types 0-I), 6 superficial SSIs and 3 bowel obstructions (1 required surgery). 6, 12, 24 months: complications stabilized at 8–10%. 4 bulging, 2 late seromas, 1 temporal SSI (1 year), 1 chronic SSI, 6 chronic pains (4 at 24 months), 8 recurrences (5.75%, 7 in mesh border, 1 complete; 6 in highly-complex). Conclusions Specialised surgeons obtained comparable to accreditation standards outcomes even the high complexity.

Flap Reconstruction Outcome Following Surgical Resection of Soft Tissue and Bone Sarcoma in the Setting of (Neo)adjuvant Therapy: A Sarcoma Center Experience.

Soft tissue and bone sarcomas are heterogeneous groups of malignant tumors. The shift in their management, with an emphasis on limb salvage, has deemed the involvement of reconstructive surgeons an integral part of their multidisciplinary treatment. We present our experience with free and pedicled flaps in the reconstruction of sarcomas at a tertiary referral university hospital and major sarcoma center. All patients undergoing flap reconstruction after sarcoma resection over a 5-year period have been included in the study. Patient-related data and postoperative complications were collected retrospectively, ensuring a minimum follow-up of 3 years. A total of 90 patients underwent treatment with 26 free flaps and 64 pedicled flaps. Postoperative complications occurred in 37.7% of patients, and the flap failure rate was 4.4%. Diabetes, alcohol consumption and male gender were associated with increased early necrosis of the flap. Preoperative chemotherapy significantly increased the occurrence of early infection and late dehiscence, while preoperative radiotherapy was associated with a higher incidence of lymphedema. Intraoperative radiotherapy was associated with late seromas and lymphedema. Reconstructive surgery with either pedicled or free flaps is reliable, but it can be demanding in the setting of sarcoma surgery. A higher complication rate is to be expected with neoadjuvant therapy and with certain comorbidities.

Late Seroma in Breast Implants: A Coronavirus Disease 2019 Phenomenon?

The coronavirus disease 2019 (COVID-19) pandemic has been challenging in all aspects of the medical field with new clinical presentations constantly arising. Plastic surgeons are not immune to this and need to be aware of their implications. There has been a recent report of late periprosthetic seroma (breast implant) as a clinical manifestation of COVID-19 infection. To our knowledge, this phenomenon has not been further reported. We present a 53-year-old immunocompromised lady who developed late seroma after COVID-19 infection. She eventually required explantation of the implant and is awaiting autologous reconstruction. It is likely that we will increasingly continue to see this phenomenon of implant complications as a result of COVID-19 infection and should be watchful, especially regarding potential immunocompromised patients.

Late seroma and infection in patients with cranioplasty implants after lateral suboccipital craniectomy

Late wound complications, such as dehiscence or infection, are rare following the retrosigmoid approach, especially when the cranial opening is small. Here, we report two cases of late wound complications after lateral suboccipital craniectomy and cranioplasty with polymethyl methacrylate. Sudden neck rotation was the cause of complications in both cases, and seroma formation, wound dehiscence, and infection developed subsequently 4 and 19 years after surgeries, respectively.

Commentary on "Late seroma of the breast in association with COVID-19 infection: two case reports".

Commentary on "Late seroma of the breast in association with COVID-19 infection: two case reports".

Commentary on "Late seroma of the breast in association with COVID-19 infection: two case reports" by Martínez Núñez P, Pérez González M & Juárez Cordero A.

Commentary on "Late seroma of the breast in association with COVID-19 infection: two case reports" by Martínez Núñez P, Pérez González M & Juárez Cordero A.

Unilateral Late Breast Seroma After Breast Augmentation Surgery Associated with the Use of an Electrical Muscle Stimulation Device

Unilateral Late Breast Seroma After Breast Augmentation Surgery Associated with the Use of an Electrical Muscle Stimulation Device

A Single Center's Clinical Experience With Ergonomix Breast Implants.

This retrospective study reports on the early experience of a private surgical center with Motiva Ergonomix SilkSurface breast implants. The aim of this study was to examine the incidence of complications and satisfaction levels in women who received primary and revision breast augmentation or augmentation-mastopexy with Ergonomix SilkSurface breast implants. A total of 356 consecutive patients received Ergonomix SilkSurface breast implants between April 2014 and October 2018 by 3 different surgeons and were followed-up for a minimum of 12 months. Complications were assessed by measuring the rate of rupture, capsular contracture, malposition, late seroma, double capsule, reoperation, symmastia, ptosis, extrusion, and infection. Satisfaction with aesthetic results was assessed on a Likert scale by both surgeon and patient. Only 6 major complications were observed in these 356 patients (712 implants): 1 unilateral implant ptosis ("bottoming out") at 12 months (0.14%) and 2 capsular contractures (0.28%), 1 at 14 months and 1 at 2 years. At all time points, 98% of the patients were "extremely satisfied or very satisfied" with the aesthetic results, and the surgeons categorized the outcomes as "very important or important improvement" in 96% of the cases. Motiva Ergonomix SilkSurface devices provided high patient satisfaction up to more than 5 years postoperatively with very few complications. These data are consistent with other reports in the literature. The observed favorable outcomes might be attributed, at least in part, to the bioengineered "cell-friendly" surface of these implants.

Late seroma of the breast in association with COVID-19 infection: two case reports.

The SARS-CoV-2 pandemic is giving rise to a wide range of clinical manifestations, which can affect all organs and systems. Due to the enormous and constantly growing number of infected people, even the rarest complications will be observed in a very high number of patients. Late periprosthetic seroma of the breast has gained importance since the description of Breast Implant Associated Anaplastic Large Cell Lymphoma (BIA-ALCL), but this entity is not the only cause. Among the causes of non-BIA-ALCL late seroma, we can include those of mechanical origin and those of non-mechanical origin. Within the latter, the common denominator is the triggering of an aberrant immune reaction that generates an inflammatory exudate from the periprosthetic capsule that gives rise to the seroma. We present two cases of late breast seroma as a manifestation of SARS-CoV-2 infection.Level of evidence: Level V, diagnostic study.

Breast implant-associated anaplastic large cell lymphoma: a case report with a history of spontaneously resolved late seroma

We report a case of breast implant-associated anaplastic large cell lymphoma (BIA-ALCL), which had a history of spontaneous resorption of late seroma before diagnosis. A 47-year-old woman with a history of augmentation mammoplasty with round textured implants in January 2013 presented with a swelling on her right breast 6 years later, which was diagnosed as late seroma with suspected intracapsular rupture using ultrasonography (USG). Although aspiration was not done at the time of the initial USG, the seroma resolved spontaneously within weeks. A further workup proceeded with USG-guided aspiration followed by magnetic resonance imaging. Cytology of the aspirated fluid showed atypical cells. Cell block cytology and immunohistochemical staining confirmed the diagnosis of BIA-ALCL. En bloc resection with total capsulectomy and explantation was performed as curative surgery. Pathologic stage pT2N0M0 was confirmed and the patient was followed up without further treatment. Although the classic presentation of BIA-ALCL is known as late persistent seroma, an atypical manifestation such as spontaneous resorption may occur, as in the current case. A high level of suspicion and a thorough investigation with appropriate modalities will make it possible to detect this rare and potentially devastating disease.

Хирургическая тактика при местном рецидиве после подкожной мастэктомии с одномоментной реконструкцией

Background. Breast reconstruction after mastectomy is an important factor affecting patient’s quality of life. Mechanical and biological features of acellular dermal matrix (ADM) allows simplifying the breast reconstruction and achieving better functional and aesthetic results, especially for women with medium and large breast size. Objective: to present the first experience of breast reconstruction with ADM in Ukraine with the analysis of the technical aspects of surgeries, early and delayed surgical, oncological and functional results. Materials and methods. This work is the retrospective analysis of implant-based breast reconstruction with ADM in the Breast Unit of LISOD Hospital of Israeli Oncology. Results. Thirty-five operations were performed for 27 patients, 34 of them were immediate and one — delayed reconstruction. The average age of women was 44 (30–71) years. Therapeutic procedures were performed in 25 (73.5 %) cases, prophylactic — in 4 (11.8 %), symmetrised — in 5 (14.7 %). Eighteen (52.9 %) mastectomies were nipple-sparing. The average time of follow-up was 46 (6–84) months. Early complications such as ischemia and skin necrosis, infection, hematoma were detected in 11 (31.4 %) cases. Late complications such as infections and late seromas were observed in 4 (11.4 %) cases. Five (14.3 %) revisions were performed, 3 (8.6 %) implants were lost. Grade 3 capsular contracture was found in 5 (14.3 %) reconstructed breasts. Systemic recurrence occurred in 6 patients, 5 of them died. We had performed a survey about aesthetic and functional results in 21 (77.8 %) patients: 19 (90.5 %) were very satisfied and 2 (9.5 %) — were rather satisfied. No patients were unsatisfied. Conclusions. Despite the certain complications rate, the mechanical and biological features of ADM allow us to make an effective breast reconstruction even in patients with medium and large breasts. It provides for the further lipografting, and promotes good aesthetic and functional results after breast reconstruction.

Preliminary outcomes and comparison of polytech POLYtxtⓇ and MESMOsensitiveⓇ breast implants with focus on late seroma: Single-surgeon, retrospective cohort study on 621 consecutive aesthetic breast surgery cases

Recent history shows incomplete understanding of the long-term interaction between breast implants and biological tissues. Although complications of silicone-textured implants have been previously reported, conclusive data are still controversial due to the lack of reduced bias, long-term, comparative studies. We present our preliminary outcomes of 3 years aesthetic use of POLYTECH silicone POLYtxtⓇ and MESMO SensitiveⓇ implants. This article is a retrospective analysis of 621 patients who have undergone primary aesthetic breast surgery (breast augmentation (BA) or augmentation mastopexy). The surgeries were performed by a single surgeon using Polytech microtextured silicone implants (POLYtxt and MESMO). Complications, with main focus on late seroma, were assessed and compared based on texturization type. From January 2015 to September 2018, 358 patients were treated with POLYtxt and 263 with MESMO-textured implants. Incidence of complications, such as hematoma, infection, early seroma, capsular contraction and malposition/rotation was comparable between the two groups. Incidence of late seroma was, respectively, 6.4% (POLYtxt) and 0% (MESMO) resulting in a statistically significant difference between the two groups. Overall complications and reinterventions were 12.5%-9.2% (POLYtxt) and 4.5%-3.8% (MESMO), respectively, showing a significantly lower occurrence in the MESMO group. This reduced bias study shows an increased risk in overall complications and reoperations with POLYtxt surface implants compared with MESMO. Furthermore, we registered an exceptionally high rate of late seroma when the more "aggressive" POLYtxt texturization was used. Conversely, a significantly low incidence of adverse events was registered with the MESMO surface, which has turned this device in our first choice in daily practice.

Current status of breast implant-associated anaplastic large cell lymphoma in South Korea

Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a unique type of lymphoma caused by breast implants. Concerns about BIA-ALCL have increased worldwide, and three domestic cases have been reported in South Korea. However, the incidence of the disease is not clear, and the risk probability has been reported to be up to 1/3,000. The most important factor in BIA-ALCL is the texturing of the implanted devices. Since the type of texturing is heterogeneous among products and companies, it is important for physicians to be aware of the spectrum of products and their implied risk. The pathophysiology of BIA-ALCL is presumed to be a combination of chronic inflammation related to the microenvironment and genetic predisposition. Further studies will allow accurate diagnosis and prognosis of the disease. The prognosis of BIA-ALCL is favorable if patients with late seroma or pericapsular masses are diagnosed early and complete surgical removal is achieved. Accurate diagnosis includes cytology or pathology with immunohistochemistry, including the CD30 protein and anaplastic lymphoma kinase. An essential factor in surgical success is radical excision with total capsulectomy. However, there is no evidence for prophylactic removal of a textured implant without symptoms. Careful examination and consultation should precede the implant removal, which can lead to deformity or complications. Domestic collaboration among healthcare providers for diagnosis and treatment is needed along with active reporting and registration of suspected patients. Finally, worldwide cooperation and improved awareness leading to regular surveillance are crucial in the era of BIA-ALCL.

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Background: Chronic encapsulated seroma following breast cancer surgery is a rare entity, and management is challenging. We present clinical and pathologic findings in a patient with extensive history of bilateral refractory breast seroma successfully treated with capsulectomy. Case presentation: A 71-year-old woman with previous early BRCA2 associated, node-negative breast cancer, developed late onset seroma following endocrine therapy, unilateral breast-conserving surgery, and completion of adjuvant radiotherapy. Non-simultaneous bilateral mastectomy was later performed to treat infection and reduce risk of contralateral breast cancer. Each surgery was followed by chronic seroma. After six years of ineffective treatment attempts with repeated aspirations, the patient successfully underwent bilateral capsulectomy. She remains seroma-free nine months from time of capsulectomy. Conclusion: This is the first report of late onset bilateral encapsulated breast seroma following mastectomy without axillary dissection. When managing breast seroma refractory to conventional treatment encapsulated seroma and prompt capsulectomy should be considered.