[How to manage late periprosthetic fluid collections (seromas) in patients with breast implants?]

The widespread use of silicone implants in reconstructive and aesthetic breast surgery led to an increase in the incidence of breast implant associated anaplastic large cell lymphoma, BIA-ALCL, mainly associated with the use of macro-textured breast implants. BIA-ALCL is a serious complication presenting clinically as a late onset periprosthetic seroma. Thus, its occurrence became an alarming sign feared by most plastic surgeons. Therefore, a good knowledge with respect to early diagnosis, subsequent workup, and treatment is crucial in the management of periprosthetic seroma. The diagnosis of late onset seroma is clinically evident. Although idiopathic seroma is the most common cause, BIA-ALCL should be always eliminated. A complete workup is usually necessary. An ultrasound performed by a radiologist specialized in breast imaging followed by an ultrasound guided puncture is imperative. Consequently, the cytological and the bacteriological analysis will orient us toward the etiology (infectious, neoplastic or mechanical). A standardized management of late periprosthetic seroma does not exist, with various factors are to be taken into consideration. These include the surgeon's experience, the diagnosis, and the medical institution facilities. Although idiopathic seroma is managed by a simple puncture and drainage, other causes may require a surgical procedure with implant removal, capsulotomies, and/or total capsulectomies.

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.

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

BACKGROUND

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.

METHODS

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.

RESULTS

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.

CONCLUSIONS

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.