I had a breast augmentation four years ago (under the muscle with gummy bear silicone implants). I discovered I had a seroma which was aspirated and tested for ALCL. The tests came back negative, but now the seroma has reappeared. My doctor suggested compression can completely rid me of this seroma and keep it from returning. Thoughts?
No, the answer is to remove your current implant and switch to something with a smooth shell, remove the existing scar capsule, place a drain, and see what happens over time. Compression will not get rid of the seroma. You have to get rid of why the seroma is forming, and that is usually from the implant itself, especially if it is textured.
Published on Jul 11, 2012
So happy you tested negative for ALCL, and I hope you have had a complete discussion with your physician about the testing done to confirm that you are negative. Recurrent seroma formation is not something I would expect and I don't know that compression will be enough to eliminate the problem on its own. I would think another discussion with your physician is in order.You can certainly try it, but recognize that it may or may not be successful and further procedures may be required to solve the problem. Hope this helps.
J. Wethe, MD
Published on Jul 11, 2012
Thank you for your question. In my experience the seroma will most likely continue to return. If your breast is firm (meaning there is a capsular contracture), then I recommend you consider a capsulectomy and implant replacement with the placement of a drain which remains in place until the drainage is less than 25 milliliters for 24 hours. If you are not uncomfortable, and there is no evidence of infection nor capsular contracture, then a trial of compression would not be unreasonable. Best of luck to you and I hope you are feeling better soon.
Published on Jul 11, 2012
That would be really great, but highly unlikely. I normally use a Seroma catheter which usually takes care of the problem. It can usually be placed by radiology to avoid injury to the implant.
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Published on Jul 11, 2012
It may be worth re-aspirating the seroma and retesting. If it continues to be a problem, consideration should be given to removing the whole capsule and creating a new pocket.
Published on Jul 11, 2012
When a seroma occurs early postop as with a tummy tuck, compression right after aspiration may be helpful to "close off the space," and minimize the re-accumulation of fluid. The appropriate initial treatment for a delayed onset breast implant-related seroma as you had is to attempt aspiration to determine if infection, or very rarely, ALCL is present. Great news that your seroma tested negative for ALCL.
Recurrence of the seroma is not unusual and may require a repeat aspiration (ultrasound guided) and placement of a drain to attempt to keep the area collapsed for a short period. Compression alone is unlikely to be effective. Occasionally, it my be necessary to re-operate with removal and/or replacement of your implants. You should discuss all of your options with your plastic surgeon.
Published on Jul 11, 2012
In the case of late seroma (once more concerning causes have been ruled out), compression is worth a try. However repeated aspirations are unlikely to be successful. In my practice, if a third intervention is necessary I will usually abandon compression in favor of exploration and drainage.
Especially in the case of textured implants, there is potential for developing a double capsule when a textured device pulls away from the wall of the pocket. Once organized, this seroma pocket is unlikely to resolve on it's own.
As always, discuss your concerns with a board certified plastic surgeon (ABPS).
Published on Jul 11, 2012