Encapsulated chronic recurrent seroma following modified radical mastectomy: surgical resection and reconstruction by muscle-sparing latissimus dorsi flap—a case report and review of literature

Abstract

: Seroma formation is known to be one of the most common complications following modified radical mastectomy. The best management for seroma is prevention by manoeuvres such as attentive surgical techniques, suction drains, quilting and fibrin sealant. Recurrent seroma could be managed by repeated aspiration, compression, seroma-desis and/or sclerotherapy. Surgical intervention is reserved for refractory cases. We hereby present the case of a 43-year-old woman with chronic recurrent chest wall and axillary seroma following modified radical mastectomy that persisted for over 6 years. It was associated with neuropathic pain and stiffness around the axillary and shoulder regions. This was eventually managed by surgical excision of the encapsulated seroma, which was found to receive feeding lymphatic vessels and to entangle a nerve in the scar tissue. The defect was reconstructed with a muscle-sparing latissimus dorsi flap (MS-LD). The patient had uneventful recovery. She had no recurrence of seroma and significant improvement in the quality of life on follow-up, 10 months down the line. We present the progression of the condition, its treatment modalities, the interesting operative findings and post-operative outcome. We also performed a review of literature for the management of similar cases. Patients with chronic encapsulated seroma can pose a challenging treatment dilemma. Surgical resection of such seromas should be considered when managing cases which are refractory to conservative efforts. Importing vascularised tissue to the resection site of the seroma cavity is recommended when the overlying skin is under tension, of poor quality, affected by radiotherapy changes and at risk of delayed wound healing.