Comparing Seroma Formation at the Deep Inferior Epigastric Perforator, Transverse Musculocutaneous Gracilis, and Superior Gluteal Artery Perforator Flap Donor Sites after Microsurgical Breast Reconstruction

Abstract

Background Seroma formation is the most common donor site complication following autologous breast reconstruction, along with hematoma. Seroma may lead to patient discomfort and may prolong hospital stay or delay adjuvant treatment. The aim of this study was to compare seroma rates between the deep inferior epigastric perforator (DIEP), transverse musculocutaneous gracilis (TMG), and superior gluteal artery perforator (SGAP) donor sites. Methods The authors conducted a retrospective single-center cohort study consisting of chart review of all patients who underwent microsurgical breast reconstruction from April 2018 to June 2020. The primary outcome studied was frequency of seroma formation at the different donor sites. The secondary outcome evaluated potential prognostic properties associated with seroma formation. Third, the number of donor site seroma evacuations was compared between the three donor sites. Results Overall, 242 breast reconstructions were performed in 189 patients. Demographic data were found statistically comparable between the three flap cohorts, except for body mass index (BMI). Frequency of seroma formation was highest at the SGAP donor site (75.0%), followed by the TMG (65.0%), and DIEP (28.6%) donor sites. No association was found between seroma formation and BMI, age at surgery, smoking status, diabetes mellitus, neoadjuvant chemotherapy, or DIEP laterality. The mean number of seroma evacuations was significantly higher in the SGAP and the TMG group compared with the DIEP group. Conclusion This study provides a single center's experience regarding seroma formation at the donor site after microsurgical breast reconstruction. The observed rate of donor site seroma formation was comparably high, especially in the TMG and SGAP group, necessitating an adaption of the surgical protocol.

Reduction in Seroma Rate Following Deep Inferior Epigastric Perforator Flap with Umbilectomy Utilizing Progressive Tension Sutures

“…Although donor-site seromas are a well-known complication in breast reconstruction, the role they play in patients undergoing umbilectomy in DIEP flaps was previously lacking in the literature. [10][11][12]14 We speculated the increased seroma rates after umbilectomy were likely due to increased dead space and lack of fixation of the abdominal flap to the fascia. 20,21 Previous studies have shown PTS are efficacious in minimizing seroma rates in abdominoplasty.…”

“…9 Abdominal seromas are one of the most common complications in DIEP flap reconstruction as well as abdominoplasties, expected in up to 40% of patients in both groups. [10][11][12][13][14] Seromas, and the required treatment, can be taxing on the patient and provider, resulting in patient concern, unplanned follow-ups, and increased risk for the progression into a chronic condition. 15,16 The use of progressive tension sutures (PTS) in abdominoplasties has been shown to significantly decrease seroma rates when compared with drains alone.…”

Similarity of Seroma Rate at the Medial Thigh following Free Flap Harvesting or Medial Thigh Lift: A Systematic Review and Meta-analysis

“…Finally, a total of 28 studies comprising 1,096 patients were included in the meta-analysis ( Table 1 ). Seventeen studies presented data on TMG flaps, 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 five studies on PAP flaps, 17 , 27 , 28 , 29 , 30 and six studies on MTL. 3 , 4 , 5 , 6 , 7 , 8 , 9 Nearly all studies (96%), except for the study by Candiani et al (1995), 7 were published after 2005.…”

“… 2 The seroma occurrence rate after free flap harvest from the medial thigh or thigh plasty ranges between 0% and 29% in the literature. 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 Patients with seroma experience discomfort and are at an elevated risk of developing wound complications such as infection, wound dehiscence, and necrosis. Additionally, seroma can contribute to an extended recovery period with prolonged aftercare treatment and, hence, higher medical expenses.…”