Diagnostic and management challenges of late chest wall mass following implant-based breast reconstruction: a case report

Sep 30, 2026

Uploaded by Grenda

Peri-prosthetic late hematoma after breast implant procedures is defined as a hematoma occurring more than 6 months post-operation and remains rare, with scattered literature reports. An 85-year-old patient developed a spontaneous late hematoma nearly 20 years after implant-based breast reconstruction and adjuvant chemotherapy, demonstrating the need for a broad differential when a chest wall mass cannot be biopsied. MRI showed a peri-implant effusion with a partially enhancing heterogeneous mass; ultrasound-guided biopsy failed due to retro-implant positioning, requiring open biopsy. Pathology confirmed organized hematoma, and flow cytometry excluded BIA-ALCL or BIA-SCC, supporting comprehensive workup integrating history, exam, imaging, and pathology.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages7

Reading Time18 min

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Introduction

Case report

Case RepoRts in plastiC suRgeRy and Hand suRgeRy 2026, Vol. 13, no. 1, 2610546 [https://doi.org/10.1080/23320885.2025.2610546](https://doi.org/10.1080/23320885.2025.2610546) CASE REPORT Diagnostic and management challenges of late chest wall mass following implant-based breast reconstruction: a case report Kathryn Howarda, Garrett M. Minorb and Alisha B. Paranzinob aCollege of Medicine, university of Kentucky, lexington, Ky, usa; bdivision of plastic surgery, university of Kentucky, lexington, Ky, usa ABSTRACT Peri-prosthetic late hematoma following breast implant procedure is defined as a hematoma presenting longer than 6 months after operation and is a rare complication with sporadic cases reported throughout literature. We present a case of an 85-year-old patient who developed a spontaneous late hematoma nearly 20 years following implant-based breast reconstruction and adjuvant chemotherapy to illustrate the importance of maintaining a wide differential when approaching a chest wall mass that cannot be biopsied in a patient who has previously received breast implants. MRI revealed a peri-implant effusion with a heterogeneous mixed signal partially enhancing mass measuring 3.2 x 4.3 x 1.7 cm, posterior to the left breast implant. The patient had bilateral Mentor smooth, round, silicone, 350 cc implants in the submuscular plane. Ultrasound-guided biopsy was attempted and unsuccessful due to inability to displace the implant and access the mass, indicating the need for an open biopsy. The patient underwent radical left chest wall mass excision of the posterior implant capsule, removal of the left implant, and closure of the anterior capsule. Final pathology confirmed the diagnosis of organized hematoma. Immunophenotyping flow cytometry was utilized to rule out BIA-ALCL or BIA-SCC. Our case is unique in that biopsy was unable to be obtained given retro-implant position of the mass and that the diagnosis and etiology of late hematoma formation following smooth round silicone implants has been infrequently discussed in literature. Providing a comprehensive workup considering patient history, physical exam findings, imaging, and pathology ensures a wide differential optimizing patient outcomes. Introduction ARTICLE HISTORY Received 7 August 2025 Accepted 7 December 2025 KEYWORDS Chest wall mass; late hematoma; implant-based breast reconstruction; case report Implants are commonly used in breast surgery for both cosmetic and reconstructive purposes [1] . Patients can experience adverse effects associated with breast implants, which are separated into early and late complications based on the time of operation [1] . Early complications can include infection, hematoma, seroma, mastectomy flap skin necrosis, wound dehiscence, and implant extrusion and occur within weeks following the procedure [2] . Late complications occur within months to years and include capsular contracture, implant leakage or rupture, breast implant associated anaplastic large cell lymphoma (BIA-ALCL) and breast implant associated squamous cell carcinoma (BIA-SCC) [2,3] . Hematoma is a well-known complication most commonly occurring during the early postoperative period. Peri-prosthetic hematomas present in 2–10.3% of patients following breast implants and typically occur within 3 days following the operation [3] . Possible etiologies have been identified as inadequate hemostasis, trauma, or coagulopathy [4] . A peri-prosthetic late hematoma following a breast implant procedure is defined as a hematoma presenting longer than 6 months after operation and is a rare complication with sporadic cases reported in literature [2,3] . The etiology of late hematoma formation is not clear, but previous reports have identified several possible causes including direct trauma, clotting disorders, anticoagulant use, physical strain, post-chemotherapy immunodeficiency, use of corticosteroids atthe time of implantation, or the friction force betwee

FAQs

How is peri-prosthetic late hematoma after breast implant surgery defined?

It is defined as a hematoma presenting longer than 6 months after the operation. It is described as a rare complication with sporadic literature reports.

What imaging and biopsy findings were central to the case?

MRI demonstrated a peri-implant effusion with a heterogeneous partially enhancing mass measuring 3.2 x 4.3 x 1.7 cm posterior to the left implant. Ultrasound-guided biopsy was attempted but was unsuccessful due to inability to displace the implant and access the mass.

How were BIA-ALCL or BIA-SCC ruled out?

Immunophenotyping flow cytometry was used to rule out BIA-ALCL or BIA-SCC. Final pathology confirmed organized hematoma after surgical excision.

Sep 30, 2026

Uploaded by Grenda