AboutAlan M. Engler, MD, FACS Expertise Dr. Engler has answered over 2700 plastic surgery questions for Allexperts. His expertise is in cosmetic plastic surgery including breast surgery (breast enlargement with implants, breast reduction, breast lifts), liposuction, eyelid surgery, tummy tucks, facelifts etc.
Dr. Engler has been listed as one New York`s Top Doctors, and as "One of the World's Most Famous Aesthetic Surgeons" (Aesthetic Surgery, TASCHEN Books, Angelika Taschen, Editor). He is the author of 4 books, including "BodySculpture" (a best-selling plastic surgery book on breast surgery, liposuction and tummy tucks), "EyeScapes" (Plastic Surgery of the Eyelids), "Restylane," and "The Slim Book of Liposuction."
Dr. Engler has two US Patents for surgical instruments that he's designed, and has appeared on numerous television shows, including The Tyra Banks Show, The Ricki Lake Show (four times), and the Dr. Keith Ablow Show. Videos of his appearances are available on YouTube (SEARCH FOR "DR. ENGLER"). His website is www.bodysculpture.com.
Experience Dr. Alan Engler is a board-certified plastic surgeon in New York and the author of BodySculpture - Plastic Surgery of the Body for Men and Women (ISBN 0966382749) one of the top-selling plastic surgery books on amazon.com, barnesandnoble.com, etc.
Education/Credentials Dr. Engler graduated from Yale University (undergraduate) and the College of Physicians and Surgeons of Columbia University (medical school). He did his residency training in General Surgery and, after that, Plastic Surgery, at the Montefiore Medical Center in New York. He is on the faculty of the Albert Einstein College of Medicine in New York.
Question Dear Dr. Engler,
I had a breast augmentation in Dec 2008, subpectoral with silicone implants.
I had an uncomplicated postoperative period until last month when I suddenly
developed swelling in my right breast. I have since had an MRI, and CT
confirming the fluid or seroma, and had it aspirated once by a interventional
radiologist by guided ultrasound. All was well until it filled up a week later.
At the same time I was place on Prednisone and subsequently Medrol but now
discontinued those since they did not help at all. My surgeon would like to
proceed next with a Seroma Cath and leave in the drain for a while. I will be
having this procedure this week by the radiologist again. This would be my
second draining. My questions is: after this draining should I stop draining it
and consider a capsulectomy/capsulotomy if the fluid returns? I had a
second opinion by a PS and this was his recommendation from the get go. Is
this warranted so soon? I am not ready for another surgery so soon and I
know that I am not infected as the culture from the first tap came out
negative. Can Seromas spontaneously resolve? I'm worried that the fluid will
keep on filling. What has beeen your experience in managing Seromas?
Thank you for your response.
Sandra
Answer Dear Sandra,
I'm obviously sorry for the problems you've been having.
It's hard for me to say anything with absolute certainty since I have not been able to examine you at any point, but here's what I would say in general:
1) Once an early seroma has been identified around an implant it is important that it be addressed as expeditiously as possible. It's not necessarily unreasonable to make one attempt to take care of it closed (ie, without surgery), but I don't know that I would wait longer than that.
2) The first procedure, though, was a simple aspiration with the insertion of a drain. I would probably have recommended that a drain be inserted at that time.
3) Had the drain not worked, I would certainly think that an open procedure would be indicated now. Since you're planning to have a drain inserted, it's okay to do that now BUT
4) If THAT doesn't work, then I would go back in, open it up, remove the implant (temporarily), irrigate the pocket copiously and try to put the implant back in. I'm not so sure about a procedure to the capsule at this point, since it's probably inflamed and would then be likely to bleed a lot. Most capsule procedures described (capsulotomy or capsulectomy) are done when things are relatively stable.
5) I have actually had some success in getting seromas to resolve with constant, adequate drainage alone - but it has not always worked. That's why I would give it a chance with the drain, but then you may be forced into doing something more invasive.
