Bilateral late hematomas after breast augmentation mimicking anaplastic large cell lymphoma: A case report

RATIONALE: Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is rare, but its incidence has recently increased. It is characterized by a sudden onset of seroma collection after implantation of textured breast implants. However, BIA-ALCL may be confused with late hematoma, which is also a rare finding in aesthetic breast surgery. The cause of late hematoma is mostly unknown, and patients rarely present with specific symptoms. PATIENT CONCERNS: We presented a case of late hematoma that occurred in a patient who underwent augmentation mammoplasty 25 years ago and was on anticoagulants for 7 years. DIAGNOSES: Ultrasonography and magnetic resonance imaging could not rule out the possibility of BIA-ALCL. INTERVENTIONS: Bilateral implant removal was performed, and massive amounts of late hematoma and organizing tissues were removed. OUTCOMES: The pathologists confirmed the biopsy results as late hematoma with organizing tissues. Capsules from both sides were confirmed as fibrous capsules with chronic inflammation and foamy macrophage infiltration. LESSONS: Although malignancy needs to be primarily ruled out, late hematoma can occur beyond expectations, especially in anticoagulated patients, and must be included in the differential diagnosis.