Atypical Capsular Contracture with Delayed Intracapsular Hematoma After Breast Implantation for Reconstruction

Late spontaneous hematoma (> 6 months postoperatively) after breast reconstruction using implant is rare complication. We experienced a case of capsular contracture with a unique clinical form of intracapsular hematoma 13 years after implantation of smooth saline filled implants. This report presented the mechanism of complication examined through chart-review, histological morphological analysis, and literature review to help evaluation and treatment of various symptoms around the breast implant capsule. A 51-year-old woman underwent a unilateral breast reconstruction using tissue expander insertion in 2005, and underwent saline implant insertion after a year. A patient has been assessed through computed tomography (CT) and ultrasonography annually for cancer screening in General Surgery department, and in 14 years after implantation, she was referred to the Plastic Surgery department as a finding intracapsular multi-layering lesion around implant. She underwent implant removal and capsulectomy. The excised capsule was sent for histological evaluation. There were no trauma event, calcifications, or implant rupture. Symptoms of swelling and stiffness gradually developed. The etiology of late hematoma following implantation has been poorly characterized. There are opinions that delayed hematoma can be induced by capsule microfracture, which may be due to the rigidity of the contracted capsule, and that it may be caused by friction between the capsule and the implant when there is pathological contracture. It is thought to be an old hematoma capsule contracture that can be mistaken for tumor lesions, and it was concluded that our case corresponds.