According to Master, Doctor Ho Cao Vu, Thu Ngan, 39, from Long An, visited Nam Saigon International General Hospital with a deformed breast and persistent pain in her left shoulder. The patient stated she underwent breast implant surgery in 2022 through an incision in the lower half of the areola. Over time, however, her right breast showed signs of implant displacement, while her left side became firm and misaligned.

Doctors removing a foreign object, a gossypiboma, from the breast. Photo: Dr. Cao Vu

Following a clinical examination, Doctor Ho Cao Vu diagnosed the patient with grade 4 capsular contracture. She required implant removal, capsulectomy, and reconstruction of both implant pockets, in preparation for a subsequent breast augmentation in 6 to 12 months.

During the surgery, the team observed that the right breast implant pocket was thick with inflammation, and the pocket tissue was thin. There was insufficient space in the upper inner quadrant and displacement in the lower outer quadrant, which caused the implant to shift and sag. The 255 cc Motiva implant was intact, so doctors proceeded to suture the breast pocket to stabilize its structure for the next implant placement.

On the left breast, the pocket tissue was noticeably thicker with inflammation. Upon dissecting the implant pocket, the team discovered the 255 cc Motiva implant was degraded, with numerous folds on its surface and the internal gel aging and turning yellow. After removing the old implant, doctors confirmed severe grade 4 capsular contracture and found a fibrotic medical gauze mass encased in the axillary region.

"The foreign object had been present for four years, causing the left breast cavity to become inflamed, hyperemic, and form a gossypiboma, a rare complication in surgery", the doctor explained.

The medical gauze found in the left axillary region. Photo: Dr Cao Vu

According to NCBI, the term gossypiboma refers to a mass of tissue formed in the body due to inadvertently forgotten surgical gauze during an operation. When non-absorbable cotton gauze is left behind, the body reacts in two ways: either by forming pus (leading to abscesses, causing pain, swelling, and sometimes external fistula) or by fibrosis (the body encases the gauze with fibrous tissue, forming a firm, painless mass that develops silently over years).

Thu Ngan's case is rare in Doctor Cao Vu's 20 years of practice because the patient exhibited no unusual clinical signs, apart from shoulder pain and a firm, deformed left breast. During ultrasound, the gauze was also difficult to detect as the foreign object had completely fibrosed, blending with the surrounding tissue in the axillary fossa.

Faced with the fibrotic gossypiboma and significant inflammatory adhesions, Doctor Ho Cao Vu used an ultrasonic scalpel, which has cutting and hemostatic capabilities, combined with point dissection to completely remove the gauze and the fibrous capsule, minimizing damage to healthy surrounding tissue.

The fibrotic gossypiboma and significant inflammatory adhesions. Photo: Dr Cao Vu

"Immediately after, we sent the gossypiboma and fibrous capsule for histopathological examination. Thanks to the ultrasonic scalpel, bleeding was controlled, and the breast cavity secreted less fluid, so the patient did not need a drain after surgery, reducing pain and shortening recovery time", the doctor stated.

Clinically, the surgery relieved the patient's left shoulder pain, and she regained normal arm movement. Previously, Thu Ngan reported frequent left shoulder aches and difficulty moving her arm up and down. She spent most of her time undergoing physical therapy, but her condition did not improve.

The specialist advises women to undergo thorough examinations if they experience unusual symptoms after breast surgery, such as firmness, deformation, or unexplained pain in the breast, armpit, or shoulder areas, even if an ultrasound does not detect any issues.

"Some cases of fibrotic foreign bodies, like Thu Ngan's, may not be clearly visible on ultrasound, but with clinical experience, doctors can detect abnormal signs and intervene promptly", Doctor Cao Vu added.

* Patient's name has been changed

Hieu Chau

In addition to his collaboration with Nam Saigon International General Hospital, Master, Doctor Ho Cao Vu is also responsible for professional and technical expertise at Dr. Cao Vu Aesthetic Center.