First BREATHE.
A seroma is a collection of fluid. The majority of swelling on one side is NOT something big and bad. But you are right to take it seriously. It could be from trauma. It could be blood. It could be your textured implant tore from the capsule and fluid collected there. Again the majority of swelling is NOT cancer.
BUT there are some issues which present with unilateral swelling which are more serious- the biggest one being a cancer that starts in the breast implant capsule. The cancer most commonly talked about is ALCL (super rare 1:3,000-80,000 patients, only seen in textured implants and mostly only with Biocell texturing). See my blogs on ALCL HERE. There are now some reports (18 patients reported so far) of squamous cell cancer occurring in the capsule around implants as well.
What you need to do:
- See a doctor. When did this start? Did you have any trauma? Has it been getting better or worse? Any other symptoms or changes you feel?
- You need to have imaging to look at the fluid. This can be via ultrasound and MRI with and without contrast.
- Get a copy of your operation report or your implant card. You were registered when you put the implant in, Mentor, Allergan (McGhan/Natrelle), and Sientra are the big brands. When was it placed? Is it textured?
- If there is fluid per the ASPS guidelines:
- Preoperatively have aspiration of the fluid to look at cytology: This should include immunohistochemistry including CD30, ALK, CK 5/6, p63 and flow cytometry to look for T-cells, squamous cells and keratin.
- If disease is found, a consider a PET-CT prior to surgery.
- During surgery: Collect fresh seroma fluid, representative portions of the capsule, and look for specific pathology to rule out ALCL land squamous cell cancer.
- Seroma fluid or mass should be evaluated with Wright Giemsa stained smears and cell block immunohistochemistry/flow cytometry testing for cluster of differentiation (CD30) and Anaplastic Lymphoma Kinase (ALK) markers, as well as Cytokeratin 5/6 (CK 5/6) and p63.
- Flow cytometry should include instructions to look for T cells, squamous cells, and keratin.
- All confirmed or suspected BIA-SCC data should be entered into the PROFILE Registry (Data entry mechanism forthcoming). And data for all patients with seroma should be entered into the National Breast Implant Registry (NBIR).
I have seen patients with seromas on one side. (Only a few during my entire career). These were NOT anything bad. Just a fluid collection. You want to deal with it because the swelling can be painful, it distorts the breast shape, and will likely make you uneven on one side. But you also want to make sure it isn’t the rare presentation of something else.