LATE SEROMAS AFTER IMPLANT-BASED BREAST ENLARGEMENT SURGERY
Objective. To evaluate risk factors, clinical history and surgical treatment of late seromas after implant-based breast enlargement surgery. Methods. Late seromas were diagnosed in 19 cases (1.4%) of 1387 implant-based breast enlargement surgeries in total at the long-term follow-up, 6 months - 16 years after the first surgery. Six of these cases underwent the initial surgeries at other hospitals. The incidence of late seromas was 0.9%. Seromas were diagnosed via ultrasound and computed tomography. Results. The origins of late seromas were related to capsular contracture (n=6), rupture of the implant (n=3), mastitis (n=4), general infection (n=1), lactation (n=1), three were discovered during surgeries, and one had no apparent risk factors for its origin. The accumulation of milk around the breast prosthesis in the early postpartum period was called “milkoma.» Late seromas were divided into three groups: small with their volume up to 50 ml (29.3±7.5 ml), discovered in 8 (42.1%) patients, medium ranged in volume between 50 to 150 ml (97.7±37.8 ml), discovered in 4 (21.1%) patients, and large - more than 150 ml (271.4±111.3 ml) in volume, discovered in 7 (36.8%) patients. Three patients with small seromas were treated with antibacterial, anti-inflammatory and physiotherapy; one case of milkoma was treated via repeated transcutaneous needle aspiration and lactation suppression, and one case of seroma was treated by drainage. 14 (73.7%) patients required repeat surgeries: 6 patients with small seromas underwent capsulectomy with the replacement of breast implants and drainage; 5 patients with large seromas or signs of mastitis, and/or infected fluid in the presence of medium seromas underwent capsulectomy with implant removal and drainage, and 3 patients required implant removal with drainage. Implants were not replaced until 6 months later. Conclusions. Risk factors for formation of late seromas include capsular contracture, rupture of implants. Anti-inflammatory therapy or capsulectomy with the replacement of breast implants is effective in cases of small seromas. Implant removal, complete capsulectomy and drainage are required for cases of large seromas or signs of mastitis and/or infected fluid. What this paper adds For the first time, the proposed classification and characterization of late seromas after implant-based breast enlargement surgery are described; milkoma, as a variant of late seroma during lactation in the early postpartum period. It has been established that capsular contracture, implant rupture, and decreased immunity are risk factors for late seromas. It has been shown that with small seromas, capsulectomy and primary mammary gland reprosthesis are possible, with large seromas, implant removal and seroma drainage, reprosthesis no earlier than after 6 months are necessary.