Late Fluid Collection in Breast Implant-Rule Out ALCL is Imperative- Raleigh,NC*

This 45-year-old womanpresented with a late large fluid collection in her right breast. She had a textured silicone gel implant placed approximately 15 years prior. Any late fluid collection around a breast implant warrants investigation. In her case, with a McGhan textured implant it was absolutely imperative to rule out ALCL which is a rare T cell lymphoma that can occur around a textured implant. The patient had initial drainage of the fluid collection with submission for cytology. Fortunately this did rule out ALCL. Ultimately she had removal of her implant with capsulectomy performed as an initial step. The very thickened leathery capsule was associated with old blood collection. The capsule was negative for ALCL as well. She ultimately underwent exchange of her implants bilaterally. Because of the significant degree of capsular removal she did have some minor asymmetries but her now soft breasts with smooth-walled gel implants were much more comfortable. Late fluid collections or seromas are usually associated with textured implants and could be a sign of ALCL. The textured surface of the implant may incite a chronic inflammation which creates the fluid collection and is felt to be a trigger for development of ALCL. All late fluid collections must be handled by a Board Certified plastic surgeon experienced in complex breast implant problems.