Lee Jong Ho, Hong Hyun Ki, Kim Won Hwa, Kim Hye Jung, Lee Jeeyeon, Park Ho Yong, Yang Jung Dug, Lee Joon Seok
Department of Plastic and Reconstructive Surgery, School of Medicine, Kyungpook National University, Daegu, Korea.
Department of Radiology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, Korea.
Gland Surg. 2021 Apr;10(4):1515-1522. doi: 10.21037/gs-20-854.
Hematomas represent one of the postoperative complications in patients undergoing reconstructive or aesthetic breast surgery with a silicone implant. Although there are few reports of intracapsular hematoma, those presenting late hematoma after reconstructive and aesthetic augmentation surgeries are rarer. This study reported two Asian patients with late hematoma after reconstruction and aesthetic breast surgery. A 54-year-old female patient underwent bilateral nipple-sparing mastectomy with immediate breast reconstruction using anatomically shaped textured implant for intraductal carcinoma in August 2019. Contralateral nipple-sparing mastectomy was performed for the gene mutation on the left breast, which was immediately reconstructed with an anatomically shaped textured implant. In a 1-year postoperative magnetic resonance imaging evaluation, an extracapsular hematoma was found on the right side, which was removed following the removal of both implants. Another case was a 63-year-old female patient who underwent augmentation of both breasts with smooth round implants and experienced right unilateral swelling and painless firmness about 30 years postoperatively. A preoperative magnetic resonance imaging evaluation showed both intracapsular and extracapsular ruptures on the right breast and a bulging implant herniation on the left breast. During the operation, hematoma, implants, and capsule were all removed. The excised capsule was sent for histological evaluation. Slightly dark colored blood was emptied before removing the semisolid-state intracapsular hematoma. In both cases, the patients responded well postoperatively and were discharged to their homes with no postsurgical complications, including seroma, or additional hematoma on the breasts. The etiology of late hematoma following breast augmentation or reconstruction has been poorly characterized. Further reports are needed to clearly establish the reasons for this increase in late hematoma formation.
血肿是接受硅胶植入物进行乳房重建或美容手术患者的术后并发症之一。虽然关于囊内血肿的报道较少，但在重建和美容隆乳手术后出现迟发性血肿的情况更为罕见。本研究报告了两名亚洲患者在乳房重建和美容手术后出现迟发性血肿。一名54岁女性患者于2019年8月因导管内癌接受了保留乳头的双侧乳房切除术，并立即使用解剖形状的纹理植入物进行乳房重建。因左乳房基因突变进行了对侧保留乳头的乳房切除术，并立即用解剖形状的纹理植入物进行重建。在术后1年的磁共振成像评估中，右侧发现了一个囊外血肿，在取出两个植入物后将其清除。另一例是一名63岁女性患者，她接受了光滑圆形植入物隆乳术，术后约30年出现右侧单侧肿胀和无痛性硬结。术前磁共振成像评估显示右侧乳房既有囊内破裂也有囊外破裂，左侧乳房有植入物突出疝出。手术过程中，血肿、植入物和包膜均被切除。切除的包膜送去进行组织学评估。在清除半固态囊内血肿之前，先排空了颜色略深的血液。在这两例中，患者术后恢复良好，出院回家时没有出现包括血清肿或乳房额外血肿在内的手术并发症。乳房隆乳或重建术后迟发性血肿的病因尚未得到充分明确。需要更多报告来清楚地确定迟发性血肿形成增加的原因。
