Management Of Seroma Research Articles

Current use of drains and management of seroma following mastectomy and axillary surgery: results of a United Kingdom national practice survey

PurposeUp to 40% of the 56,000 women diagnosed with breast cancer each year in the UK undergo mastectomy. Seroma formation following surgery is common, may delay wound healing, and be uncomfortable or delay the start of adjuvant treatment. Multiple strategies to reduce seroma formation include surgical drains, flap fixation and external compression exist but evidence to support best practice is lacking. We aimed to survey UK breast surgeons to determine current practice to inform the feasibility of undertaking a future trial.MethodsAn online survey was developed and circulated to UK breast surgeons via professional and trainee associations and social media to explore current attitudes to drain use and management of post-operative seroma. Simple descriptive statistics were used to summarise the results.ResultsThe majority of surgeons (82/97, 85%) reported using drains either routinely (38, 39%) or in certain circumstances (44, 45%). Other methods for reducing seroma such as flap fixation were less commonly used. Wide variation was reported in the assessment and management of post-operative seromas. Over half (47/91, 52%) of respondents felt there was some uncertainty about drain use after mastectomy and axillary surgery and two-thirds (59/91, 65%) felt that a trial evaluating the use of drains vs no drains after simple breast cancer surgery was needed.ConclusionsThere is a need for a large-scale UK-based RCT to determine if, when and in whom drains are necessary following mastectomy and axillary surgery. This work will inform the design and conduct of a future trial.

A New Ultrasound-assisted Protocol to Avoid Seroma-related Complications in Prepectoral Breast Reconstruction with Acellular Dermal Matrix

Summary: Seroma, with its secondary complications, represents one of the major unsolved problems in direct to implant breast reconstruction with acellular dermal matrix. The seroma formation not only represents a complication, but causes other secondary complications such as major infections, surgical dehiscence, and implant loss. These lead to the failure of the reconstruction. The authors have developed a new ultrasound protocol for early diagnosis and management of seroma, with the aim of detecting and treating early seroma through a series of ultrasound-guided suctions. In this way, we want to avoid the onset of seroma-related complications. After 12.5 months of mean follow-up time, we performed 22 fluid aspirations, and no seroma recurrence was reported, as well as no secondary complications. The authors believe that the introduction of this novel ultrasound protocol allows the plastic surgeon to actively and promptly manage seroma.

Comparison of Ligasure versus conventional technique for total thyroidectomy.

Objective: The objective of this study was to compare thyroidectomy by Ligasure™ with conventional technique in terms of mean intra operative blood loss. Study Design: Randomized Control Trial. Setting: Surgical Unit-I, Allied Hospital Faisalabad. Period: August 2018 to April 2019. Material & Methods: All the patients were admitted through out-patient department. Informed consent was taken. The patients were counseled on expected outcome particularly on cosmesis and possible complications, especially the expectant management of seroma. Clinical examination was done to confirm the diagnosis. Preoperative investigation was carried out in the ward. Patients were divided in 2 groups by lottery method. Group A included patients in which total thyroidectomy was done using Ligasure vessel sealing system. Group B included patients in which total thyroidectomy was done using conventional thread ligation technique. All patients were given general anesthesia. Patients in each group had surgery by respective method. Intraoperative blood loss was measured by weighing the dry gauze preoperatively and soaked gauze post operatively. Difference in weight was given estimated blood loss that was recorded in milliliters. Results: In our study, out of 70 cases, 42.86%(n=15) in Group-A and 34.29%(n=12) in Group-B were between 18-50 years of age whereas 57.14%(n=20) in Group-A and 65.71%(n=23) in Group-B were between 51-70 years of age, mean+sd was calculated as 50.86+7.94 years in Group-A and 53.26+6.57 years in Group-B, 34.29%(n=12) in Group-A and 28.57%(n=10) in Group-B were male whereas 65.71%(n=23) in Group-A and 71.43%(n=25) in Group-B were females, comparison of thyroidectomy by Ligasure™ with conventional technique in terms of mean intra operative blood loss shows that 61.31+4.37 ml in Group-A and 72.11+3.83 ml in Group-B, p value was 0.0001. Conclusion: We concluded that Ligasure™ is significantly better when compared with conventional technique during thyroidectomy in terms of mean intra operative blood loss.

Mixed Metal Oxide Nanoparticle Formulations for the Treatment of Seroma

Seroma formation is a well-recognized postoperative complication for many plastic and general surgical procedures. Although various tissue adhesives and substances have been used in an effort to treat seroma formation, no therapies have been established clinically. Recently, the nano-bridging phenomenon has been introduced as a promising approach to achieve tissue adhesion and strong closure of deep skin wounds in rats. The present study seeks to assess the potential of nano-bridging beyond skin wounds in a rat model of seroma. Seromas were induced in 20 Lewis rats through bilateral axillary lymphadenectomy, excision of the latissimus dorsi and cutaneous maximus muscles, and disruption of dermal lymphatics. On postoperative day (POD) 7, the seroma was aspirated on both sides. A bioactive nanoparticle (NP) suspension based on zinc-doped strontium-substituted bioglass/ceria nanoparticles (NP group) or fibrin glue (fibrin group) was injected into the right seroma cavity, while the left side was left untreated. On POD 14, the NP group showed complete remission (no seromas at all), while the fibrin group recorded a reduction of only 63% in the seroma fluid volume. The NPs exerted local anti-inflammatory and neo-angiogenic effects, without any detectable systemic changes. Moreover, the ceria levels recorded in the organs did not surpass the background level, indicating that the nanoparticles stayed at the site of application. This study is a promising first example demonstrating the ability of inorganic nanoparticle formulations to reduce seroma formation in a rat model, without any detectable systemic adverse effects. These results emphasize the potential of nanotechnological solutions in the therapeutic management of seroma in the clinical setting.

Seromas Following Pediatric Spinal Deformity Surgery: Is Operative Management Necessary?

Seromas are known complications after pediatric spinal deformity surgery. Although many surgeons perform an early debridement to prevent deep surgical site infections (SSIs), a less invasive approach to seroma management has not been studied. We hypothesized that a conservative approach to seroma management would be safe and yield equivalent outcomes. We performed a retrospective review of patients who developed a postoperative seroma with or without nonpurulent drainage. Inclusion criteria were patients below 21 years who underwent primary posterior spinal fusion from 1996 to 2016 and developed a postoperative wound seroma. Seromas were clinically defined as an afebrile patient with a fluid collection that was soft and nontender to palpation and without induration or erythema. Growing spine surgeries and revision procedures were excluded from this study. Twenty-five of 790 total patients with a mean follow-up of 57.8 months (±48.5 mo) developed a seroma. Seromas were identified at a mean of 13.6 days postoperatively and resolved after a mean of 12.2 days following the presentation. Seromas occurred in 12 patients with idiopathic scoliosis, 12 with neuromuscular scoliosis, and 1 patient with Scheuermann kyphosis. All cases were managed conservatively with monitoring of the incision without an operative procedure. In cases of spontaneous drainage, a sterile dressing was applied to the wound and changed as needed until drainage ceased. Two patients underwent bedside needle aspiration and 5 patients received prophylactic antibiotics at the treating surgeon's discretion. All cases resolved spontaneously without development of an acute SSI. Three cases subsequently developed a late SSI (range, 18 to 38 mo postoperatively). Two had idiopathic scoliosis and 1 had neuromuscular scoliosis. None of these seromas drained spontaneously. Conservative management of postoperative seromas after pediatric spinal deformity surgery is appropriate. It is unclear if seromas contributed to the development of the 3 late infections. Further studies are needed regarding the relationship of late infections in seroma patients. Level IV-case series.

Prospective comparison of indwelling cannulas drain and needle aspiration for symptomatic seroma after mastectomy in breast cancer patients

AimsPostoperative seroma is the most frequent sequelae after mastectomy and axillary surgery with no optimal regimens for seroma resolution recommended in routine clinical. Indwelling cannulas with needle and catheter have been widely used in long-term medication therapies, but evidence of indwelling cannulas in seroma management after mastectomy is lacking. The purpose of this study is to evaluate the feasibility of indwelling cannulas in seroma management after mastectomy.MethodsPatients who underwent modified radical mastectomy (MRM) and developed symptomatic seroma after removal of the drains between August 2017 and December 2018, were randomized into two groups either indwelling cannulas drain of seroma (Group A) or needle aspiration of seroma (Group B). We prospectively compared the number of visits for seroma, the time from removal of the drain to the final seroma resolution and the cost between the methods.ResultsA total of 860 patients underwent MRM between August 2017 and December 2018, among which 86 patients who developed symptomatic seroma after removal of the drains, were randomized into two groups either Group A or Group B. The number of visits for seroma in Group A was 2.35 ± 0.69 times, which was less than those in Group B (4.86 ± 1.06 times). Similarly, the time of drain removal to final seroma resolution in Group A was 4.65 ± 0.78 days, which was shorter than 7.09 ± 1.54 in Group B. In Group A, the total mean cost per patient (25.81 ± 7.71 RMB) was less than the total mean cost per patient (49.30 ± 9.85 RMB) in Group B. Cost savings were noted with using indwelling cannulas in seroma management.ConclusionIt is feasible to drain indwelling cannulas drain for postmastectomy seroma, with less visits for patients, rapid seroma resolution and less cost. Indwelling cannulas can be an efficient, cost effective solution to treat symptomatic seroma after breast surgery.

Donor Site Seroma Management after Latissimus Dorsi Flap for Post-Mastectomy Reconstruction in Patients with Breast Cancer: A Meta-Analysis of Randomized Controlled Trials

Minor, Garrett M.; Jalfon, Michael J.; Fleming, Martin D. MD, FACS; Dickson, Paxton V. MD, FACS; Deneve, Jeremiah L. DO, FACS; Glazer, Evan S. MD, FACS; Yakoub, Danny MD, PhD, FACS Author Information

The Expanding Role of Diagnostic Ultrasound in Plastic Surgery.

Ultrasound in plastic surgery is quickly finding new applications. Ultrasound surveillance may replace ineffective individual risk stratification and chemoprophylaxis for deep venous thromboses. Abdominal penetration can be a catastrophic complication of liposuction. Preoperative screening for fascial defects may reduce risk. Limiting buttock fat injections to the subcutaneous plane is critical for patient safety, but it is difficult to know one's injection plane. The author's use of diagnostic ultrasound was evaluated from May 2017 to May 2018. Ultrasound scans were used routinely to detect deep venous thromboses. Patients undergoing abdominal liposuction and/or abdominoplasty were scanned for possible hernias. Other common applications included the evaluation of breast implants, breast masses, and seroma management. The device was used in surgery in 3 patients to assess the plane of buttock fat injection. One thousand ultrasound scans were performed during the 1-year study period. A distal deep venous thrombosis was detected in 2 patients. In both cases, the thrombosis resolved within 1 month, confirmed by follow-up ultrasound scans. A lateral (tangential) fat injection method was shown to safely deposit fat above the gluteus maximus fascia. Ultrasound scans are highly accurate, noninvasive, and well-tolerated by patients. Some of these applications are likely to improve patient safety. Early detection of deep venous thromboses is possible. Unnecessary anticoagulation may be avoided. Subclinical abdominal defects may be detected. Ultrasound may be used in the office to evaluate breast implants, masses, and seromas. In surgery, this device confirms the level of buttock fat injection.

“Axillary Space Obliteration”—An Effective Technique in Reducing Seroma Formation after Mastectomy and Axillary Dissection

Introduction: Seroma is the commonest complication of breast cancer surgery, and although its consequences most often cause no more than discomfort and anxiety, more important sequelae include flap necrosis and wound dehiscence. Seroma management can be difficult and frustrating for both the patient and surgeon. Numerous methods to reduce post-mastectomy seroma formation have been tried with no consistent success. Methods: Sixty patients were prepared for modified radical mastectomy. Of those, the study group contains 30 patients and the control group contains 30 patients. Study group had axillary space obliteration while the other had the conventional procedure; total drain outputs were recorded daily for all patients prior to drain removal. The drains were removed when the daily drainage was less than 30 ml. Results: This study contains 60 patients, and the study group contains 30 patients, and the control group contains 30 patients. Age, tumor size, No. of positive lymph nodes were of no significant differences to be more concise on the effect of axillary space obliteration. The mean of day of drain removal in the control group was 13.2 ± 1.0 days (9 - 18 days) with a mean of total drain output of (4700 ± 90.3 ml) (3722 - 4930) while the mean in the study group of day of drain removal was 7.1 ± 1.3 days (6 - 12) with a mean of total drain output of 1530 ± 422 ml (range 600 - 2100 ml) p . Conclusion: Obliteration of axillary space is a valuable procedure that significantly decreases seroma after mastectomy and axillary dissection.

Abstract: Assessing the Association Between Seroma and Surgical Site Infection in Immediate Breast Reconstruction

PURPOSE: Several preoperative and intraoperative risk factors have been implicated in infectious complications of immediate breast reconstruction, however the link between common postoperative sequelae and surgical site infection (SSI) remains largely anecdotal. Published rates of seroma and SSI often trend in parallel, and authors have hypothesized that seroma formation may independently promote infectious complications.1,2 The current study aims to assess and quantify the postulated association between seroma and the risk of SSI in immediate breast reconstruction. METHODS: A retrospective review of the Tracking Outcomes and Operations in Plastic Surgery data registry was conducted to identify all cases of immediate breast reconstruction (IBR) between 2009–2012. Cohort characteristics and 30-day outcomes were compared between cases with and without seroma using Pearson’s chi-squared for categorical variables and student t-tests for quantitative variables. Multivariate logistic regression analysis was performed to control for confounding variables while assessing the association between seroma formation and the risk of SSI. RESULTS: Of the 6,729 cases of IBR identified in the study period, 4489 were classified as prosthetic and 2240 as autologous, with 717 pedicled TRAM flaps, 611 latissimus flaps, and 912 free flaps. Acellular dermal matrix (ADM) was used in 17.2% of cases. The seroma rate was 2.9 percent and the SSI rate was 1.9 percent. Bivariate analysis showed that seroma was associated with a 3.6 percent increase in absolute risk of surgical site infection (p<0.0001). Multivariate analysis confirmed that the presence of seroma independently increased the likelihood of SSI in both prosthetic and autologous IBR (odds ratio 7.195,p=0.015; odds ratio, 4.496, p=0.013, respectively). Of note, ADM usage was not associated with SSI when confounding variables were accounted for. CONCLUSION: This study is the first to quantify the independent and statistically significant association between seroma and surgical site infection in immediate breast reconstruction. Seroma is associated with a seven- and four-fold increased likelihood of SSI in prosthetic and autologous reconstruction, respectively. Irrespective of whether postoperative seroma represents an independent nidus of infection or an indicator of aberrant wound healing, our results indicate that a seroma in the setting of recent mastectomy has a greater propensity for infection, and thus we advocate for more attentive surveillance and thoughtful management of seroma following immediate breast reconstruction. REFERENCES: 1. Chun YS, Verma K, Rosen H, et al. Implant-based breast reconstruction using acellular dermal matrix and the risk of post-operative complications. Plast Reconstr Surg 2010;125:429–36. 2. Ganske I, Verma K, Rosen H, et al. Minimizing complications with the use of acellular dermal matrix for immediate implant-based breast reconstruction. Ann Plast Surg. 2013 Nov;71(5):464–70

Seroma in Prosthetic Breast Reconstruction.

Seroma, as a complication of prosthetic breast reconstruction, results in patient distress, increased office visits, undesirable aesthetic outcomes, and--importantly--may escalate to infection and frank prosthesis loss. Herein, the authors review the pathophysiology and risk factors and attempt to collate published practices for avoidance and management of seroma. A systematic literature review was performed using MEDLINE, Web of Science, Embase, and Cochrane Library for studies published between 2000 and January of 2015. Random-effects meta-analysis was used to estimate the overall pooled incidence of seroma and to examine the effect of drain number and acellular dermal matrix use. Seventy-two relevant primary articles and three systematic reviews were identified. Fifty-one citations met inclusion criteria, including two randomized controlled trials. The overall pooled incidence was 5.4 percent (95 percent CI, 4.1 to 6.7 percent). Obesity, acellular dermal matrix, and preoperative irradiation were cited risk factors. Pooled relative risk for acellular dermal matrix was 1.83 (95 percent CI, 1.28 to 2.62). Drain practices were collated from 34 articles. Seromas following prosthetic breast reconstruction are complicated by the hypovascular, proinflammatory milieu of the mastectomy skin flap, the geometrically complex dead space, and the presence of a foreign body with potential contamination and biofilm. There is reasonable evidence to suggest that these factors contribute to a progression of seroma to infection and prosthesis loss. These findings have motivated this summary article on current practice guidelines and strategies to prevent and treat seromas. Risk, II.

Postmastectomy seroma: how much is it affected by serum levels of IL-6 and CRP and how much is it reduced by intravenous hydrocortisone injection?

Background Seroma is extremely common after breast surgery, and this could be because of the inflammatory response during wound healing. Several factors such as interleukin-6 (IL-6) and C-reactive protein (CRP) have been detected in the seroma fluid that support this assumption; therefore, inhibition of the inflammatory response by using hydrocortisone might decrease seroma formation. We aimed to evaluate the effect of adding hydrocortisone to the anesthetic regimen in the perioperative serum level of IL-6 and CRP and consequently in postmastectomy seroma formation. Patients and methods The study included female patients with primary operable breast cancer who were randomly allocated to two groups; each included 40 patients. Patients in group I received general anesthesia with hydrocortisone, and patients in group II received general anesthesia without hydrocortisone. Venous samples were collected for measuring IL-6 serum levels before surgery, 6 h after the end of the procedure, and 24 h after the procedure and for measuring CRP serum levels before surgery and 24 h after the procedure. All patients were followed up postoperatively for registration of the total drainage volume until drain removal, timing of drain removal, incidence of seroma formation, and management of seroma. Results Patients in group I had a lower total drainage volume ( P = 0.001), had the drain removed earlier ( P = 0.009), and had a lower incidence of postmastectomy seroma formation ( P = 0.005). Postoperative serum levels of IL-6 and CRP showed a significant decrease in group I compared with group II. Conclusion Postmastectomy seroma is likely a proinflammatory process and can be reduced by giving intravenous hydrocortisone on induction of anesthesia and 2 h later, which significantly decreases the inflammatory mediators (IL-6 and CRP) that significantly reduce the incidence of seroma.

Continuous high-pressure negative suction drain: new powerful tool for closed wound management: clinical experience.

Although various reconstructive flap surgeries have been successfully performed, there still are difficult wound complications, such as seroma formation, wound margin necrosis, delayed wound healing, and even flap failures. The negative-pressure wound therapy has been described in detail in the literature to assist open chronic/complex wound closure in reconstructive surgery. However, the negative-pressure wound therapy was difficult to be applied under the incisional closed wounds. A total of 23 patients underwent the various reconstructive flap surgeries with continuous high-pressure negative suction drain. Instead of using regular suction units, Barovac (50-90 mm Hg, Sewoon Medical, Seoul, Republic of Korea) drainage tubes were connected to the wall suction unit, providing continuous high-powered negative pressure. In addition, continuous subatmospheric suction pressure (100-300 mm Hg) was applied. Outcome of the measures was obtained from the incidence of seroma, volume of postoperative drainage, hospitalization period, and incidence of other typical wound complications. Dead space was evaluated postoperatively with ultrasonography. Using continuous high-pressure negative suction drain, successful management of seroma was obtained without any major complication such as wound infection, flap loss, and wound margin necrosis, except for only 1 case of seroma after discharge from the hospital. The indwelling time of the drain in the latissimus dorsi donor site was significantly reduced in comparison with the authors' previous data (P = 0.047). The volume of drainage and hospitalization period were also reduced; however, these were not statistically significant. The dead space with continuous high-pressure negative suction drain was more reduced than in the control group in the immediate postoperative period and confirmed with ultrasonography. Continuous high-pressure negative suction drain might be the simple and powerful solution in the management of challenging closed wounds.

Techniques in the prevention and management of seromas after breast surgery.

Seromas are the most frequent complications following breast surgery, resulting in significant discomfort and morbidity with possible delays in commencing adjuvant therapies. Varied clinical practices exist in the techniques employed to prevent and manage seromata. This article assesses published literature on the techniques employed in prevention of seroma formation following breast surgery, evaluating the different methodologies used. Although prevention is the best strategy, seromata remain problematic and we consider their management. The principle findings were that prevention is key to the management of seromata. Methods employed to prevent seromata include suction drainage, shoulder immobilization, quilting sutures, fibrin sealants and innovative measures of managing the axilla, among others. The evidence demonstrated that a combination of quilting and drains significantly reduces the incidence and volumes of seromata. These effects are sustained by minimizing use of electrocautery, alongside increasing frequencies of axillary sentinel lymph node biopsies and node sampling. The efficacy data on fibrin sealants is inconclusive and consequently should not be routinely used alone or accompanied by quilting sutures. Clinically significant seromas deemed 'symptomatic' by patients and complicating infected seromas should be aspirated. There are limited data on the recommended treatment of established seromas with a paucity of high-quality studies and further research involving randomized trials are indicated.

Auricular seroma: A new concept in management

Aim: Auricular seroma is a cystic swelling with a collection of serous fluid between the perichondrium and cartilage. The successful treatment of auricular seromas remains a challenge because this disease has a high propensity for recurrence. Methods: A total of 20 patients with auricular seromas were treated by remodeling a corrugated rubber drain. Results: All patients tolerated the procedure well. No patient had any collection of fluid after the removal of the splint. No patient experienced pain, fever, or edema after treatment. The seroma disappeared without disfigurement. There were no recurrences on further follow-up. Conclusion: Aspiration and splint application by remodeling a corrugated rubber drain provides very simple, minimally invasive, and effective management of seromas. It is a cost-effective treatment that prevents patient distress from fluid recollection and social embarrassment.

Classification and Management of Seromas in Immediate Breast Reconstruction Using the Tissue Expander and Acellular Dermal Matrix Technique

Tissue expander (TE)/acellular dermal matrix (ADM)-based breast reconstruction used in immediate postmastectomy breast reconstruction, although a popular technique, is not without complications.Although seroma formation is recognized and reported in the literature as a complication, little information addresses seroma(s) management. We conducted a retrospective review of 100 consecutive TE/ADM immediate reconstructions during a 2-year period, performed by a single surgeon. Data collection included patient demographics, adjuvant therapy, initial TE fill volume, time to completion of expansion, seroma formation, management of seroma, and wound complications, up to the time of definitive implant exchange. From December 2009 to December 2011, 67 patients (100 reconstructions) underwent TE/ADM immediate breast reconstruction. Thirty-one reconstructions were identified having clinically significant seroma(s). Eighteen of the reconstructions required multiple drainage procedures. With these data, a 3-group classification system was created based on the number of aspirations. In review of the 3 groups, 71% of group III required either Seroma-Cath or operative drainage beyond simple aspiration(s). Of the 100 reconstructions, 3 (3%) ended in TE explantation. Only 1 (3%) TE explantation, interestingly from group I, was attributable to seroma formation. Using the data, we devised a management strategy emphasizing attentiveness to seroma formation, recognition, and treatment. Seroma formation is a known entity linked to complications in TE/ADM reconstructive course. A seroma classification system and treatment algorithm is offered to minimize abandonment of the reconstruction and optimize outcomes.

Diagnosis and Management of Seroma following Breast Augmentation: An Update

This article is an update to the decision and management algorithms for management of periprosthetic space infection or seroma following breast augmentation, originally published in "Decision and Management Algorithms to Address Patient and Food and Drug Administration Concerns Regarding Breast Augmentation and Implants," published in the October 2004 issue of this Journal. This update specifically addresses additional diagnosis and management alternatives for management of seroma in breast augmentation patients that may relate to lymphoproliferative disorders or anaplastic large cell lymphoma.

Discussion: Diagnosis and Management of Seroma following Breast Augmentation: An Update

Discussion: Diagnosis and Management of Seroma following Breast Augmentation: An Update

Discussion: Diagnosis and Management of Seroma following Breast Augmentation: An Update

Grand Rapids, Mich. From the Center for Breast and Body Contouring. Received for publication February 20, 2011; accepted February 23, 2011. Disclosure:Dr. Hammond has a consulting agreement with Mentor and Allergan and serves as the medical director for Mentor's joint study with the U.S. Food and Drug Administration concerning the cohesive profile gel breast implant. The views, opinions, and techniques set forth in this article addressing anaplastic large cell lymphoma in women with breast implants are those of the individual author(s) and do not reflect the views, opinions, or recommendations of the American Society of Plastic Surgeons, the Journal, or the Journal editors. Any treatment recommendations contained in the article are those of the individual author(s) and are not to be considered or construed as practice guidelines, practice standards, or practice parameters. The use of any treatment technique described in the article is at the sole discretion of the physician in the exercise of his or her independent medical judgment taking into account the patient's individual circumstances. Dennis C. Hammond, M.D., Center for Breast and Body Contouring, 4070 Lake Drive, Suite 202, Grand Rapids, Mich. 49546, [email protected]

Abstract P5-14-11: Seroma Formation Is Associated with Lymphedema-Related Symptoms

Abstract Background. Seroma formation or accumulation of serous fluid is one of the most common wound complications following breast cancer surgery, occurring from 30% as supported by needle aspiration to 85% as visualized on ultrasound in women following breast cancer surgery. It is postulated that seroma formation as a resultant collection of lymphatic fluid or acute inflammatory exudates is a response to surgical trauma and acute phase of wound healing. Seroma usually leads to prolonged wound healing, tissue inflammation and subsequent fibrosis and necrosis. It has been hypothesized that seroma formation is one of the main risk factors for post-breast cancer lymphedema. Lymphedema, exerts negative impact on breast cancer survivors’ quality of life. Understanding the relationship of seroma with lymphedema and related symptoms may help to reduce the risk of lymphedema through effective management of seroma. Purpose. To explore the relationship of seroma with lymphedema and related symptoms. Materials and Methods. Data were collected from 135 breast cancer survivors using a Demographic and Medical Information interview tool, clinical assessment, and Lymphedema and Breast Cancer Questionnaire for lymphedema related symptoms. Data analysis included descriptive statistics, t-tests, Chi-square, Fisher's exact test, and correlation coefficients. Discussion. Thirty-five patients (26%) developed symptomatic seroma following breast cancer surgery as evidenced by needle aspiration. Location of seroma formation included axilla, breast, and upper chest. Of the 35 women who had seroma, 33 (94%) of them demonstrated &amp;gt; 200 ml limb volume change determined onjectively by 4cm intervals. Clinical assessment based on International Criteria for Lymphedema Diagnosis revealed that 26 of the 35 women had severe lymphedema and the 6 patients had moderate while 3 had mild lymphedema. Age, type of surgery, number of lymph nodes removed and positive axillary lymph nodes were not correlated to seroma. Body mass index (BMI) was significantly correlated to seroma (r = .172, p = .04). Pearson correlations showed seroma formation was significantly correlated with symptom cluster of lymphedema (swelling, heaviness, firmness/tightness, numbness, and stiffness; r = .224, p = .009) and inflammation (redness, higher temperature, and tenderness; r = .287, p = .001). Significantly more women with seroma experienced a greater number of lymphedema related symptoms. Having seroma, lymph nodes removed and radiotherapy together accounted for 10% of lymphedema-related symptoms (R2 = .10, p = .003). Estimated relative risk for the women who had seroma in developing lymphedema was approximately 3 times more than those who did not (p = .00). Implications: It is important to assess and manage seroma formation. Evaluating symptom clusters of inflammation and lymphedema may be one of the cost-effective strategies to detect subclinical seroma to ensure timely interventions to prevent excessive fluid production and build-up. Current routine clinical management of symptomatic seroma is needle aspiration. Further research should focus on other effective strategies to minimize seroma formation, such as strategies of promoting fluid drain and prevention of inflammation. Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P5-14-11.