Novel Technique for Sampling of Breast Implant-associated Seroma in Anaplastic Large Cell Lymphoma.

We describe a novel technique for the sampling of breast implant-associated seroma. Using a blunt-tip lipofilling cannula, we have the freedom of movement to sample all fluid collections and prevent the misfortunes of damaging the implant. Also, we have demonstrated the inability of the Coleman style I lipofilling cannula to perforate a silicone breast implant. This practical and reliable technique will prove to be useful in managing the breast implant-associated seroma, especially with the rising incidence of the anaplastic large cell lymphoma, where the sampling of seroma is mandatory.

Concern has been raised regarding the incidence of the breast implant–associated anaplastic large cell lymphoma (ALCL) over the last years.[1,2] Presentation is infrequent, and symptoms can vary; however, a chronic or unexplained seroma occurring more than 1 year after implantation of a textured breast implant should be considered as highly suspect for ALCL. In accordance with the structured expert consultation process,[3] seroma fluid needs to be sent for culture, cytology, flow cytometry, and cell bloc. Immunohistochemical analysis by means of a positive CD30 and a negative anaplastic lymphoma kinase-1 staining is considered diagnostic for ALCL. Seroma fluid sampling is commonly performed by ultrasound-guided needle aspiration. The fluid associated with ALCL tends to be cloudy and debris filled; therefore, large-caliber needles are required for adequate sampling. Radiologists are at risk of perforating the underlying breast implant.

We describe our technique for sampling breast implant–associated seroma without using sharp large-caliber needles. After local anesthetic, a stab incision is made for the introduction of a blunt-tip lipofilling cannula (Fig. 1). Hereby, we have the freedom of movement to sample all fluid collections and prevent the misfortunes of damaging the implant. Also, the lipofilling cannula is fine enough to penetrate the capsule and does not perforate an implant. We prefer the round tip 16-G Coleman style I lipofilling cannula by Mentor (Santa Barbara, Calif); however, several cannulas with an atraumatic tip can be obtained for sampling a breast implant–associated seroma. We have successfully tested the inability of the Coleman style I lipofilling cannula to perforate a textured 350-mL silicone anatomical Natrelle (Irvine, Calif) breast implant (See Video, Supplemental Digital Content 1, which demonstrates the inability of the Coleman lipofilling cannula to perforate a silicone breast implant, whereas a 23-G needle rapidly perforates the implant. This video is available in the “Related Videos” section of the Full-Text article on PRSGlobalOpen.com or available at http://links.lww.com/PRSGO/A188).

Fig. 1.

Aspiration of a breast implant–associated seroma with a 16-G Coleman style I lipofilling cannula after a stab incision in the inframammary fold.

See Video, Supplemental Digital Content 1, which demonstrates the inability of the Coleman lipofilling cannula to perforate a silicone breast implant, whereas a 23-G needle rapidly perforates the implant. First, the Coleman style I lipofilling cannula is tested. A textured 350-mL silicone anatomical Natrelle breast implant is punctured by the Coleman lipofilling cannula. The cannula is tested twice and with increasing force; however, the tip of the cannula does not perforate the implant. Second, a 23-G needle is tested. The tip of the needle rapidly perforates the same implant, even when exerting minimal effort. This video is available in the “Related Videos” section of the Full-Text article on PRSGlobalOpen.com or available at http://links.lww.com/PRSGO/A188.

Sampling of a breast implant–associated seroma by means of a lipofilling cannula can be perfectly performed under local anesthesia, on an outpatient basis, and ultrasound guidance is optional. The technique is safe and reliable; moreover, it protects the patient against iatrogenic perforation of her implant.