title: Late seromas after breast implants:  theory and practice.
abstract: BACKGROUND
  Late seromas surrounding breast implants are becoming an increasingly important issue in breast surgery. The authors report their experience with late seromas and describe their previous management options.
  
  
  METHODS
  A multicenter retrospective review of patients who developed late seromas (clinically presenting seromas without evidence of overt or documented infection more than 1 year after implant operation) was performed. Management, surgical technique, outcomes, complications, culture findings, and cytology results were recorded.
  
  
  RESULTS
  Between 2005 and 2010, 28 late seromas were identified in 25 patients. The average interval from the patient's last surgery to seroma onset was 4.7 years; 27 of 28 breasts (96 percent) had a Biocell textured device in place at the time of seroma development. The late seromas in the series were managed as follows: 15 (53.6 percent) by complete capsulectomy, seroma drainage, and new implant placement; three (10.7 percent) by seroma drainage and new implant placement but without capsulectomy; two (7.1 percent) by complete capsulectomy and seroma drainage but without implant replacement; five (17.9 percent) by only ultrasound-guided seroma drainage without the need for surgical intervention; and three (10.7 percent) by antibiotic therapy alone. All cultures and cytology studies were negative for malignancy or infection; 27 of 28 seromas (96 percent) were treated successfully by one of the described approaches.
  
  
  CONCLUSIONS
  Biocell textured implants were more likely to be associated with late seromas than were smooth shell implants. The overwhelming majority of late seromas appear to be idiopathic, without clear evidence of infection or malignancy. A graduated approach, including several different management strategies, was used to successfully manage these patients.
  
  
  METHODS
  Therapeutic, IV.
authors.affiliation: Washington, D.C.; Sea Girt, N.J.; and Toronto, Ontario, Canada From the Department of Plastic Surgery, Georgetown University Hospital; private practice; and the Division of Plastic and Reconstructive Surgery, University of Toronto.
authors.forename: Scott L
authors.initials: SL
authors.lastname: Spear
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Rottman
authors.forename: Caroline
authors.initials: C
authors.lastname: Glicksman
authors.forename: Mitchell
authors.initials: M
authors.lastname: Brown
authors.forename: Ali
authors.initials: A
authors.lastname: Al-Attar
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D019928:Breast Implantation / Q000295:instrumentation*; D018427:Breast Implants / Q000009:adverse effects*; D003131:Combined Modality Therapy; D004322:Drainage; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D011183:Postoperative Complications / Q000628:therapy; D012086:Reoperation; D012189:Retrospective Studies; D049291:Seroma / Q000209:etiology* / Q000628:therapy
chemical_list: D000900:Anti-Bacterial Agents