Capsular synovial metaplasia mimicking radiographic features of implant-associated anaplastic lymphoma

Linden, Olivia E.; Kelil, Tatiana; Greenwood, Heather; Lauw, Marietya I.S.; Strachowski, Loretta M

doi:10.1016/j.clinimag.2019.10.019

Cited by 4 publications

(6 citation statements)

References 10 publications

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“…21,22 Case reports have described synovial metaplasia as the cause of an intracapsular fluid collection that was thought in one instance to be BIA-ALCL and in another to be a ruptured saline implant. 21,23 Synovial metaplasia is a benign condition occurring in 40% to 77% of breast implant capsules independent of implant texture and fill. 24,25 In response to microtrauma from the implant moving in the capsule pocket, the capsule attempts to repair itself by developing a synovial lining analogous to an articular joint.…”

Section: Capsular Disease Presenting With Intracapsular Fluid Accumul...mentioning

confidence: 99%

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Clinical Implications and Management of Non–BIA-ALCL Breast Implant Capsular Pathology

Vorstenbosch¹,

Chu²,

Ariyan

et al. 2022

Plastic &Amp; Reconstructive Surgery

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The breast implant capsule is a dynamic structure that forms following the implantation of a device. Although normally benign, increased awareness of breast implant-associated anaplastic large-cell lymphoma (BIA-ALCL) highlights that disease may arise from the capsule. BIA-ALCL presents as a late seroma or mass but explains few of the late seromas found in breast implant patients. To date, many of these seromas lack a clear cause and are often described as "idiopathic." Several benign and malignant breast implant capsular diseases can cause a late seroma or mass, including breast implant-associated squamous cell carcinoma. Similar to early reports of BIA-ALCL, these conditions are rare and largely limited to case reports or series. The purpose of this special topic is to present a narrative review highlighting capsular abnormalities that contribute to the formation of late seroma or mass in an attempt to broaden the differential diagnosis and help plastic surgeons identify the cause. Specifically, we review the presentation and management of BIA-ALCL, synovial metaplasia, capsular epithelialization, late hematoma, double capsule, breast cancer, squamous cell carcinoma, mesenchymal tumor, and B-cell lymphoma. Although rare, plastic surgeons should consider these capsular conditions as causes of late seromas and masses. Usually, these conditions may be diagnosed by following the National Comprehensive Cancer Network screening guidelines for BIA-ALCL. Thorough evaluation and workup of late seromas and masses may lead to improved characterization of these rare breast implant capsular conditions and improve our understanding of their pathophysiology and management.

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Section: Capsular Disease Presenting With Intracapsular Fluid Accumul...mentioning

confidence: 99%

“…22,24,26 Although definitive diagnostic imaging modalities are lacking, synovial metaplasia occasionally shows capsular thickening in conjunction with peri-implant fluid. 23 This condition is managed by capsulectomy with or without implant exchange.…”

Section: Capsular Disease Presenting With Intracapsular Fluid Accumul...mentioning

confidence: 99%

Clinical Implications and Management of Non–BIA-ALCL Breast Implant Capsular Pathology

Vorstenbosch¹,

Chu²,

Ariyan

et al. 2022

Plastic &Amp; Reconstructive Surgery

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“…12 It has also been demonstrated that the presence of synovial metaplasia is highest during the first 5 years following implantation and that it decreases over time as the capsule becomes more fibrotic; thus, the malignant potential of synovial metaplasia is low. 17,21…”

Section: What’s In the Breast Implant Capsule?mentioning

confidence: 99%

“…It is generally agreed upon that synovial metaplasia is the sequela of movement of a prosthesis within a confined space within the breast or other tissues. 17,18,21 It can also occur in the absence of a prosthetic device. As fibroblasts migrate to the site, a repair process is initiated; however, because the surface of the implant is impenetrable to the fibroblasts, a chronic situation arises in which a lining forms along the inner capsule compromised of differentiated fibroblasts called synoviocytes.…”

Section: What’s In the Breast Implant Capsule?mentioning

confidence: 99%

The Capsule Question: How Much Should Be Removed with Explantation of a Textured Device?

Nahabedian

2021

Plastic &Amp; Reconstructive Surgery

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Current controversies surrounding breast implants are focused not only on the implant but also on the capsule. There has been tremendous discussion regarding how much of the capsule, if any, should be removed during explantation for benign conditions. The appearance of benign capsules is highly variable ranging from a thin membrane to densely fibrotic with calcifications. The options for capsulectomy include none, partial, complete, completeintact, and en bloc. Some patients are requesting en bloc capsulectomy even in the absence of anaplastic large cell lymphoma; however, the scientific evidence only supports this for patients with capsular malignancies. The purpose of this article is to review the old and new evidence to answer the question regarding how much capsule should be removed during explantation for benign conditions.

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“… 1 Synovial metaplasia can be identified histologically by its close resemblance to synovial tissue. 2 In patients with a history of a VP shunt, shunt migration and cerebrospinal fluid collection should be suspected. A hematoma can be identified by both fluid color and the predominance of red blood cells.…”

Section: Introductionmentioning

confidence: 99%

Delayed, dramatic breast swelling in a transgender woman: a case report

Szymanski,

Munabi,

Garcia

et al. 2023

Sexual Medicine

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Background As the number of gender-affirming procedures performed in the United States increases, physicians caring for gender-nonconforming patients, regardless of practice location and focus, will likely encounter transgender women with breast implants. Increasingly, transgender women are seeking breast feminization. However, this population is less consistently receiving surveillance and routine breast care than cisgender women. Aim This report aims to add to the growing body of knowledge addressing breast augmentation complications in transgender women and to highlight disparities in healthcare. Methods A case of breast implant–associated seroma at our institution was analyzed through chart review. A literature review was conducted using PubMed to gather all articles discussing breast implant–associated fluid collections in transgender patients. Prior to publication of this report, a Waiver of Consent was granted by the E.R.’s Institutional Review Board for the study under which this article was prepared. Results Our patient was an African American transgender woman presenting initially at age 60 with significant asymmetry due to dramatic swelling of her left breast. The patient underwent bilateral breast augmentation outside of the United States 2 decades prior. The patient noted a gradual painless increase in her left breast size starting 3 years prior. She admitted that she was hesitant to seek a second opinion after being treated dismissively by another surgeon. Subsequent management included mammography and mirrored recommendations for late breast implant–associated seromas in cisgender patients: ultrasound, aspiration for cytology and culture, and removal of the implant and capsule. Outcomes The fluid collection in our patient was determined to be a chronic hematoma and was managed surgically. Though this patient eventually achieved a good outcome, treatment was delayed due to barriers she faced as a transgender woman. Clinical Implications Literature demonstrates that recommended management of late-onset breast-implant-associated seroma does not differ based on gender identity; however, transgender and GNC adults are more likely to receive less thorough care than cisgender women. Any patients undergoing breast augmentation with implants should be routinely evaluated for late complications, including seromas, which require prompt attention and methodical evaluation due to their potentially malignant nature. Strengths and Limitations This article is limited in that it is a single report of breast seroma. It is strengthened by a PubMed review gathering all articles discussing breast-implant-associated fluid collections in transgender patients. Conclusion We propose better education of physicians on how to care for transgender and gender-diverse patients should help mitigate the neglect and late presentation of such medical conditions in this vulnerable and marginalized population.

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Capsular synovial metaplasia mimicking radiographic features of implant-associated anaplastic lymphoma

Cited by 4 publications

References 10 publications

Clinical Implications and Management of Non–BIA-ALCL Breast Implant Capsular Pathology

Clinical Implications and Management of Non–BIA-ALCL Breast Implant Capsular Pathology

The Capsule Question: How Much Should Be Removed with Explantation of a Textured Device?

Delayed, dramatic breast swelling in a transgender woman: a case report

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