• I Zhen Ma, Jee Hyeok Chung, Jinhyun Kim, and Ki Yong Hong.
• Department of Plastic and Reconstructive Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
• Medicine (Baltimore). 2023 Dec 1; 102 (48): e36231e36231.

RationaleBreast 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 ConcernsWe 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.DiagnosesUltrasonography and magnetic resonance imaging could not rule out the possibility of BIA-ALCL.InterventionsBilateral implant removal was performed, and massive amounts of late hematoma and organizing tissues were removed.OutcomesThe 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.LessonsAlthough 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.Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.

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