Chronic haematoma as a late complication of cosmetic breast augmentation

The evaluation of the delayed swollen breast in patients with a history of breast implants

Breast implants, whether placed for reconstructive or cosmetic purposes, are rarely lifetime devices. Rupture, resulting from compromised implant shell integrity, and capsular contracture caused by constriction of the specialized scar tissue that normally forms around breast implants, have long been recognized, and remain the leading causes of implant failure. It is apparent, however, that women with breast implants may also experience delayed breast swelling due to a range of etiologic factors. While a majority of delayed seromas associated with breast implants have a benign etiology, this presentation cannot be ignored without an adequate workup as malignancies such as breast implant associated anaplastic large cell lymphoma (BIA-ALCL), breast implant associated diffuse large B-cell lymphoma (BIA-DLBCL), and breast implant associated squamous cell carcinoma (BIA-SCC) can have a similar clinical presentation. Since these malignancies occur with sufficient frequency, and with sometimes lethal consequences, their existence must be recognized, and an appropriate diagnostic approach implemented. A multidisciplinary team that involves a plastic surgeon, radiologist, pathologist, and, as required, surgical and medical oncologists can expedite judicious care. Herein we review and further characterize conditions that can lead to delayed swelling around breast implants.

Bilateral Chronic Expanding Hematoma 20 Years after Silicone Breast Implant Removal

We encountered a case of a chronic expanding hematoma (CEH) that occurred bilaterally in the breast regions of a 42-year-old woman approximately 20 years after SBI removal. There have been no other reports of CEH occurring after implant removal. Furthermore, this is also the first case of a CEH that developed bilaterally in the breasts; most reported cases are of a unilaterally developed CEH. A CEH reportedly develops after a long period of time following trauma or surgery. If surgeons encounter an expanding tumor emerging from regions with such a history, they must consider the presence of a CEH even after implant removal, as in the present case. Hematomas caused by trauma or surgery are usually absorbed or are replaced with fibrous tissue. In rare cases, they can chronically increase as CEHs. Herein, we report a case of a CEH that occurred in both breasts approximately 20 years after silicone breast implant removal.

A Case Report of Capsular Contracture Immediately Following COVID-19 Vaccination

Capsular contracture is fundamentally an immunological/inflammatory response to the implant, treating it as a foreign body in need of exclusion from the immune system. The capsule surrounding the implant is populated by a rich variety of immunologically active cells such as macrophages, T lymphocytes, and myofibroblasts. Vaccination in general and the COVID-19 vaccine in particular result in specific and nonspecific activation of the immune system, including those immune cells in proximity to the implant. This phenomenon has been previously demonstrated in delayed inflammatory reactions to previously implanted hyaluronic acid fillers following COVID-19 vaccination. This report is what is believed to be the first case of the rapid development of severe ipsilateral capsular contracture in the immediate aftermath of the second dose of the BNT162b2 (Pfizer) vaccine.

An unusual case of late hematoma after implant-based breast reconstruction mimicking an anaplastic large cell lymphoma: a case report and literature review

Late hematoma associated with breast implants used in esthetic and reconstructive breast surgery represents a rare entity. These hematomas do not have a clear etiology, but triggering events like trauma, anticoagulant use, capsule contracture, or chronic inflammation are reported in literature. We describe an 82-year-old patient who developed a unilateral intra-capsular hematoma 19 years after mastectomy and breast reconstruction with McGhan 445 g implant. Differential diagnosis with anaplastic large cell lymphoma (ALCL) was considered and potential causes of hematoma were evaluated. Constant pressure forces on chest wall were defined as pathophysiological cause. A systematic literature review concerning late hematoma cases was carried out, focusing on late hematoma etiology and various surgical treatments.

Level of evidence: Level V, diagnostic study.

Late unilateral hematoma after breast reconstruction with implants: case report and literature review

Although reports of late hematoma after placement of breast implants are rare, there has been a noticeable increase in these reports in recent years. Various etiologies have been proposed, usually relating to history of trauma, anticoagulant use, or physical strain. In this case report, we describe a 61-year-old patient who slowly developed a unilateral intracapsular hematoma 2 years after breast reconstruction with Biocell (Natrelle; Allergan, Inc, Irvine, California) textured implants. This case is unique because of the intraoperative finding of 2 capsules surrounding the implant, with the hematoma between the 2 layers. We also discuss the possible pathophysiological mechanisms of this phenomenon.

LEVEL OF EVIDENCE

5.

Chronic expanding hematoma after spinal surgery

BACKGROUND CONTEXT

Chronic expanding hematoma after spinal surgery is extremely rare, with no case previously reported in the literature.

PURPOSE

To report a rare case of a chronic expanding hematoma of the spine that occurred 24 years after thoracic laminectomy and spinal cord tumor resection.

STUDY DESIGN

Case report.

METHODS

A 71-year-old man presented with a spinal mass located approximately at the level of the sixth thoracic vertebral body. The patient had undergone thoracic laminectomy with tumor resection 24 years previously. The mass had appeared 5 years after this and had gradually enlarged over 19 years.

RESULTS

The tumor was resected en bloc. The lamina and spinous processes had been partially eroded by the tumor at the fifth and sixth thoracic vertebrae, but the dura was intact. Histopathologic examination confirmed the diagnosis of chronic expanding hematoma. The hematoma had not recurred at the 1-year follow-up.

CONCLUSION

We report herein an extremely rare case of chronic expanding hematoma after spinal surgery. This entity may be considered a late complication after surgery regardless of the number of years that have passed since the index surgery.

Acute Symptomatic Hematoma with Defined Etiology Seven Years After Breast Reconstruction: A Case Report and Literature Review

Augmentation mammaplasty with implants can be complicated by hematoma formation. The majority of hematomas occur in the immediate postoperative period. There are, however, some reports of hematomas with a delayed presentation. These hematomas in the late postoperative period are rare, and many of these cases do not have a definitive mechanism of injury or develop symptoms immediately after the triggering event. A case of late capsular hematoma seven years after breast reconstruction with a saline implant following mastectomy is presented. In contrast to the majority of published cases, the patient presented with both a known and traceable cause of her bleed and with symptoms that developed immediately after the initial event. Furthermore, the mechanism of her injury was consistent with a bleeding capsular tear that was observed intraoperatively. The present case emphasizes the importance of thorough evaluation and management of patients with a history of breast reconstruction.

A case of late unilateral hematoma and subsequent late seroma of the breast after bilateral breast augmentation

BACKGROUND

A previously unreported case of unilateral recurrent late collections, namely, a hematoma and a subsequent seroma, in an otherwise healthy female patient after breast augmentation is presented.

METHODS

A case is reported together with a review of the world literature published and presented regarding late postoperative breast augmentation complications.

RESULTS

The patient was a 49-year-old woman who underwent bilateral breast augmentation in 2006. Spontaneous swelling of the left breast developed 1 year postoperatively. The patient was taken to the operating theater, where a large hematoma was found and drained and the prosthesis reinserted. No cause for the complication was identified at the operation. The patient's symptoms of left-sided breast swelling with discomfort recurred 9 months later. A large seroma was found at surgery but no blood staining. On both occasions, the implant was extracted and examined, with no fault discovered. Capsulectomy was performed, and the pocket was examined, debrided, and cauterized as necessary. On neither occasion was any remarkable pathology found clinically or in laboratory samples sent for analysis. The patient was investigated for any sensitivities or hematologic abnormalities, with no significant results.

CONCLUSION

A previously unreported case of recurrent late postaugmentation collections, namely, a seroma and a subsequent hematoma, in an otherwise well female patient is reported. The authors found no obvious reason for the recurrence in this patient.

Explantation of 41-Year-Old Implants Following Primary Breast Augmentation

The long-term affects of primary breast augmentation is a topic of controversy. This case report will highlight the long-term outcome in a woman with Ivalon sponge breast implants and the reasons for explantation. The focus of the manuscript will include mammography, capsular contracture, and late hematoma.

Haematoma as a late complication after breast reconstruction with implant

We report a patient who, 3 1/2 years after mastectomy and breast reconstruction using a Becker implant, developed haematoma around the implant. We believe this is the first description of late haematoma formation in association with tissue expander (Becker implant), the differential diagnosis of which includes infection, recurrent cancer and implant rupture.