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Case 3 hydrogel or saline is used as filler. The implants can be
A 19-year-old young female presented with asymmetrical textured, microtextured, smooth or polyurethane coated. [3,4]
breast along with right breast ptosis. She had her However, there is a paucity in literature on the pathogenesis
augmentation mammoplasty procedure using 275 mL on her of this condition and is not comprehensively defined on the
right and 345 mL on her left side. Nagor GFX cohesive gel basis of aetiology, pathogenesis, anatomical location or type
silicone textured implants were placed in muscle splitting of implants.
pocket a right internal mastopexy was performed at the same
time. Eight years later patient presented with an acute onset Intraprosthetic collection of fluid presenting
of right-sided autoinflation of breast. She was reassured as autoinflation of breast
and treated conservatively with antibiotics, cold compress Intraprosthetic collection of fluid or sterile pus though not
and pressure garments successfully without any surgical very common has been reported both in saline as well as
intervention. Her swelling subsided with in 6 weeks and has silicone gel implants. [11-14] However the process differs in the
been asymptomatic for the last 6 months [Figure 3]. two instances. In saline implants, the shell allows passage
of protein macromolecules, predominantly albumin that
DISCUSSION creates an osmotic gradient across the macroscopically
intact silicone shell allowing body fluids to enter the
Complications following augmentation mammoplasty though prosthesis. The implants can gain a large volume of fluid and
not very common can be early or late. Early complications are present as autoinflation of the breast. No extracapsular fluid
infection, haematoma and seroma and may require an urgent collection has been reported with the process concerning
[14]
surgical intervention. Late complications are infrequent saline implants. On the contrary, intraprosthetic
and may include capsular contracture, asymmetry, implant collection of fluid in silicone gel implant is almost always
rupture, implant displacement, rippling and synmastia. associated with damaged or ruptured shell that may or may
[5]
Revision for these complications can be addressed on not be macroscopically visible and there is almost always
the basis of its presentation as an elective procedure. intracapsular collection of fluid or sterile pus at the same
Autoinflation of the breast arising six months or later is an time. [11-13] The damaged shell allows intracapsular fluid to
extremely rare presentation. Such autoinflation may have gain access to the inside of the damaged implant resulting
different causes and fluid collection can be intraprosthetic, in autoinflation of the breast.
intracapsular, extracapsular or a combination of the above.
The fluid collection is equally seen in implants when silicone, Extracapsular fluid collection presenting as
auto inflation of the breast
Extra capsular collection of fluid following augmentation
mammoplasty leading to autoinflation of breast is
uncommon. The extracapsular collection of fluid resulting in
autoinflation of breast is usually associated with intracapsular
collection of fluid. The presentation was noticed following
the rupture of poly implant prothese (PIP). The defective
silicone escaping into intracapsular and pericapsular spaces
starts an inflammatory response that eventually result in
large amount of creamy fluid or sterile pus collection leading
to autoinflation of breast. The presentation was commonly
observed with the rupture of PIP implants. [11,13]

Polyacrylamide gel injections
The similar process of autoinflation of breast is also seen in
breast injected with polyacrylamide gel (PAAG). Injection of
Figure 3: (a) Preoperative picture of a 19-year-old patient presenting with
breast asymmetry; (b) eight months following augmentation mammoplasty PAAG does not always produce a distinct layer of capsule.
with right internal mastopexy, patient had 275 mL GFX Nagor textured The fluid collection can be in the periphery of the injected
implant on her right and 345 mL GFX Nagor textured implant on her left material or within injected PAAG. The combination of
side; (c) the patient presented with right-sided acute onset swelling 8
years following mammoplasty; (d) three weeks following presentation with extra and intra-PAAG collection of fluid may also present
autoinflation due to late seroma. The patient was treated conservatively as galactocele, seroma or haematoma. [15] In PAAG injection
Table 1: Details of the cases presenting with late seromas in the series
No. Age (years) Implant make Implant size (mL) Implant surface Time since Pocket of implant Treatment
characteristics surgery

1 34 Allergan 605 Textured 8 months Muscle splitting Conservative
Natralle submuscular
2 25 Allergan 310 Textured 8 months Muscle splitting Conservative
Natralle submuscular
3 19 Nagor GFX 275 Textured 8 years Muscle splitting Conservative
submuscular
Plast Aesthet Res || Vol 3 || Issue 1 || Jan 15, 2016 33