Leaking seroma following breast augmentation: technical fault or new complication?

Abstract

Sir, Breast augmentation (BA) remains the most common aesthetical operation performedworldwide [1, 2]. It is considered as a simple, reliable procedure with a low complications rate. Early complications such as hematoma, seroma and infection are well known and were referenced in the scientific literature [3]. However, we have not found any published studies regarding early seroma, leaking through the surgical wound (leaking seroma). The goal of this letter is to describe leaking seroma (LS) as an early complication following breast augmentation, to present our thoughts regarding the etiology of LS, patients’ risk group, potential treatment and ways to prevent it. We reviewed 350 consecutive patients that underwent breast augmentation by the same surgeon (ABB) in a private medical center during the years 2007–2012. Breast fascial closure was performed with interrupted stitches in 172 patients (49.1 %) and with running interlocking stitches in 178 (50.9 %). Drainage was not used in any of the patients operated in this series. Medical files and operating records were extracted, and all data were statistically analyzed. We defined leaking seroma as a serous exudate discharging from surgical wound, ranging from spots on the dressing to massive fluid leak. Empirically, chosen regimen for treatment of LS, including oral antibiotic, iodine ointment dressing, non-steroidal anti-inflammatory drugs (NSAID), and complete patient rest, was employed. Seventeen patients (4.86 %) showed signs of leaking seroma, in 16 cases unilateral and in one case bilateral. Among 350 patients, two identical female twins were operated and both of them developed LS symptoms. The incidence of LS during the study period gradually decreased as shown in Table 1. Lag time between the operation date and first LS symptoms appearance varied from 5 to 50 days with mean value 15.9±11.6 days. In five patients with massive leak, the fluid from the wound was obtained for bacteriologic examination; in this group all bacterial cultures were sterile. LS treatment regimen included oral antibiotics (usually Ceftin 500 mg×2/day), iodine ointment dressings, nonsteroidal anti-inflammatory drugs (NSAID), and rest until the symptoms’ cessation. This treatment was successful in 13 out of 17 patients (76.5 %) and duration of their symptoms ranged from 3 to 20 days with mean value 8.6±4.8 days. Patients’ postoperative course was uneventful thereafter. The lack of data regarding LS in the plastic surgery literature can be explained by problematic definition of the subject. Usually, breast implant exposure and extrusion are the result of infection. It is very difficult to differentiate leaking seroma from sub-clinical infection. In our cases, the fluid discharge from the wound was serous and pellucid; all wound cultures obtained from patients with massive leak were sterile. Previous antibiotic treatment may have prevented bacterial growth and as a result, may lead to a negative bacterial culture. The lack of data can also be explained by under-reporting of postoperative complications in aesthetical plastic surgery due to the competitive character of the private plastic surgery sector. LS development can be explained by early tissue edema and exudate fluid accumulation around breast implant as a result of foreign body reaction. In some cases, excessive fluid production and non-infectious inflammatory reaction took place and caused partial wound dehiscence and subsequent LS. * Vasileios A. Pagkalos pagkalos_v@yahoo.gr