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 am a 54 year old breast cancer survivor,i had double mastectomy in 2003 w/immed reconstruction (tissue Expanders) 2004 replaced with 500cc Saline implants 2006 had capsular contraction, replaced with silicone implants,
returned to normal activities after 6 months, and was faced with a seroma in left breast, the fluid was drained about 200cc and checked for contamination (Culture proven negative) I was sent home with drain for about a week draining 40cc a day. i assumed everything would be fine. serval months later another seroma, this time doctor did not aspirate (much smaller than last seroma) i was told my body would absord fluid. Since then the pain in both breasts, serum, limited raising of both arms, down arms, has been tremendous. I have been to pain management that shot nerve blocks in my back but pain came right back. i have seen orthopaedic specialists, thorsic. had emg tests for arms, lupus, arthritis, lyme tests , lymphedema therapist, all tests coming up negative. My mri of 2007,2008,2009 all showed slight fluid outside of the silicone implants, within the breast capsule, no evidence of rupture, and no evidence of recurrence of malignancy. Recent blood test showed HIGH C-Reactive protein level my question is does it sound to you i could NE having a inflammory response from the implant or fluid ? Doctors are reluctant to drain, they feel since slight fluid is contained in pocket with no exit, the risk of contamination if high with draining. Blood work as come up neg for infection, possibility due to the body not knowning fluid is there in its own pocket so its unseen. I don't believe the fluid is contaminated, because i show my signs of contaminated implants, no fever, no red areas on breasts, etc. I do not think taking an anti-bio would do me any good because if there no way out of pocket then there's no way in.
My implants were placed submusclar!!My other question is could it be the slight fluid causes all this pain for the past 3 years? I have looked into having implants removed, but i was told by other surgeons that the pain may not go away or possibility get worse. If it is not the fluid causing the pain then more surgery would be no benefit for me. Please advise!!!!
Thank you,
Donna
Answer from Dr. Alan Engler
www.bodysculpture.com
Hi Donna,
I wish that I had a magic wand for you, but I also don't think that the amount of fluid they're seeing on the scans, which is not very much, is likely to be responsible for pain you're having. And I also would not drain it. We don't routinely do MRI's on women who aren't having problems (though that may change with the ongoing silicone gel implant protocol) so it may be completely normal to have a little fluid there.
And, unfortunately, I agree that removing them may not even alleviate the pain, and would be a shame in view of all you've gone through. Pain is a very non-specific sign; it can be due to so many things. Yours may be from just the trauma (and scar tissue) of everything you've already gone through, from the mastectomies, to the reconstructions, etc; ie, small nerve endings have been severed or caught up in scar tissue.
At any rate, that's all just speculation on my part. I really don't know what to say except that I would not try to drain that fluid (since it sounds like a very small ammount and I think it unlikely to be the source of the problems), and I would not advise removing those implants unless it is a total last resort and with the understanding that you may then have persistent pain - and no reconstruction.
That being said, if you find on any of the forums that similar pain has been relieved by removing the implants, I would understand your making that decision.
