Patients present with severe painful breast seromas, status post blunt trauma. The patient in this example is a 34-year-old African-American female presenting with severe blunt trauma to the right breast. Notice on her preoperative photo the right breast is approximately 60% larger than the left with superior retroposition of the implant, massive swelling, asymmetry and disproportion. She presents with severe pain and history of blunt trauma 14 days ago to the medial breast.
These patients should undergo ice compression and immediate exploration of their breasts in order for complete decompression of the massive amount of fluid. The longer the fluid remains within the pocket, I believe the more encapsulation, the thicker the scar tissue becomes and it is more difficult to create a normal shape and softness to the breast. Patients should be told in preop that if there is any evidence of infection or pus that the implant should be removed and not replaced for a while, a JP drain should be placed as well as cultures taken. So, on the consent forms, possible explantation without reimplantation and drainage placement should be included. In this specific case, in the operating room it was found that the patient has a 600 cc straw-colored clear seroma with no evidence of infection. This was an enormous seroma with well over a half liter of fluid suctioned out. The pocket was subsequently irrigated, implants were replaced, and softened capsulotomies were performed.
The after photograph shows on the operating room table great symmetry and evenness of her breasts and no evidence of hardening. The patient will be maintained on antibiotics orally for seven days, the sutures removed in 14 days.