Late hematoma after aesthetic breast augmentation with saline-filled, textured silicone prosthesis

Late, progressive enlargement of the breast after augmentation mammaplasty is an extremely rare complication. We present two cases of late capsular hematoma after augmentation mammaplasty with saline-filled, textured silicone implants. The MRI and C-T scan both clearly showed fluid accumulated within the capsule in one case. In this patient, we examined the interior of the fibrous capsule endoscopically, finding no persistent bleeding source. However, the inner lining had granulated tissue with new capillary ingrowth. After replacement with smooth-surface prostheses, neither patient had recurrence of the complication. No identifiable etiology could be demonstrated, however, the breakdown of an eroded capsular artery is suspected, caused by friction between the rough surface of the textured prosthesis and the fibrous capsule.