Concepts of Seroma Formation and Prevention in Breast Cancer Surgery

Background:The most common complication after breast cancer surgery is seroma formation. It is a source of significant morbidity and discomfort. Many articles have been published describing risk factors and preventive measures. The aim of this paper is to provide a systematic review of studies and reports on risk factors and preventive measures. Surgery lies at the core of seroma formation; therefore focus will be placed on surgical ways of reducing seroma. Methods: A computer assisted medline search was carried out, followed by manual retrieval of relevant articles found in the reference listings of original articles. Results: 136 relevant articles were reviewed. Though the level of evidence remain varied several factors,type of dissection, tools with wich dissection is carried out, reduction of dead space, suction drainage, use of fibrin glue and octreotide usage, have been found to correlate with seroma formation and have been shown to significantly reduce seroma rates. Conclusion: Seroma formation after breast cancer surgery can not be avoided at present. There are however several methods to minimize seroma and associated morbidity. Future research should be directed toward the best ways of reducing seroma by combining proven methods.

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“…6 The dead space created by dissected tissue is filled with serous fluid. 7 This fluid changes composition in the days following surgery.…”

Section: Pathogenesismentioning

confidence: 99%

Prevention of seroma formation after axillary dissection in breast cancer: A systematic review

Bemmel

Velde

Schmitz

et al. 2011

European Journal of Surgical Oncology (EJSO)

160

133

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“…2,15,16,34,43 Guidelines to safely increase shoulder motion have not been established, and their development is hampered by the lack of systematic methodology to design interventions. 16 Combining modeling studies and small clinical trials may lead to an optimal, cost-effective pipeline to design effectiveness studies.…”

Section: Supplemental Video Onlinementioning

confidence: 99%

“…33 Loss of flexibility of the muscle suggests the need to start stretching exercises as early as possible; however, exercise programs that start in the first days after surgery have been associated with an increased risk of seroma formation. 2,15,16,34,43 There is no available information that provides absolute parameters for safe stretching for patients after mastectomy or breast reconstruction. However, there are studies that have investigated the healing of traumatically injured muscles in athletes and have suggested that a period of relative immobilization for a couple of days might be beneficial, while longer periods of immobilization might lead to fibrosis rather than repair.…”

Section: Supplemental Video Onlinementioning

confidence: 99%

Computer Simulation of Pectoralis Major Muscle Strain to Guide Exercise Protocols for Patients After Breast Cancer Surgery

Stegink-Jansen

Buford²,

Patterson³

et al. 2011

J Orthop Sports Phys Ther

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Early detection and successful cancer treatments have increased the number of long-term breast cancer survivors, 3,5 making optimal recovery and quality of life a primary goal. 8 Up to 50% of survivors have a loss of shoulder motion after completion of their treatments, 28,46 which often extends into a long-term impairment. 33,48 This loss of motion has been found to be predictive of reduced capability to perform functional activities 28 and has been shown to be related to depressive symptoms in a group of 183 older women. 13T T STUDY DESIGN: Descriptive study. T T OBJECTIVES:To quantify and rank the order of strain (length change in proportion to the resting length) of 3 portions of the pectoralis major (PM) muscle during various exercises. T T BACKGROUND:A biomechanical foundation on which to base exercise prescriptions for patients after breast cancer surgery is lacking. T T METHODS: An interactive, 3-D, computergraphic simulation system, developed to study biomechanical properties of the musculoskeletal system, was used to simulate movements of the glenohumeral, scapulothoracic, and scapuloclavicular joints of the shoulder, and to estimate strain in 3 portions of the pectoralis major (PM) muscle throughout the motions. The computed tomography scans of 2 male cadavers and literature review formed the basis for the estimations used in the model. Strains in the clavicular, midsternum, and abdominal regions of the PM were expressed as percent strain: [(change in muscle length/resting length) × 100]. Exercise motions were based on PM muscle anatomy and published breast cancer rehabilitation protocols. T T RESULTS:Strains of the PM regions ranged from -21% shortening of the clavicular region during flexion to 55% lengthening of the abdominal region during the overhead stretch. Strain between adjacent regions was most uniform for the movement of abduction with external rotation, and least uniform with flexion. T T CONCLUSION: PM muscle lengtheningestimates were not linearly proportioned to shoulder joint motions, and varied for 3 portions of the PM. This information may help clinicians and researchers to estimate lengthening of PM portions throughout measurable shoulder motions.

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“…The technique is versatile and can also be used for other procedures such as conservative aspiration of a large scrotal hydrocoele. 1 High success rates have resulted in the technique of anastomosis remaining largely unchanged since this time. Here we describe a refinement on this technique that optimises venous length and helps prevent kinking of the draining AV fistula vein.…”

Section: Figure 2 Assembled Equipment For Seroma Drainagementioning

confidence: 99%

Vacuum-assisted sterile drainage of large post-operative seromas: the Royal Marsden technique

Fitzgerald

Hayes

Strauss

2011

Ann R Coll Surg Engl

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In closely related vessels, chamfering of the vein minimises kinking with a minimal loss of venous length. However, with widely spaced vessels chamfering alone does not prevent kinking and may serve to significantly shorten the draining vein. Figure 1B shows that when the vein is anastomosed directly 'as it lies', without rotation, the length disparity between the heel and toe of the anastomosis leads to kinking of the vein at point X, the apex of the fistula. DISCUSSION Figure 1C shows that by rotating the vein through 90º, from the 'as it lies' position, prior to anastomosis, heel to toe length disparities are minimised, thereby avoiding kinking of the draining vein and maintaining flow and patency. ment, seroma fluid can be briskly evacuated into the 400ml vacuum drain. This can be disconnected and replaced via the Luer lock connector should further drainage be required, without re-siting the needle or compromising sterility of the closed system. If a sterile fluid sample is required, this can be taken from the drain following aspiration. DISCUSSION The causes of seromas are not fully understood although increased age, weight, lymphatic disruption and use of extensive electrocautery have been implicated. 1,2 Numerous treatments for seromas have been trialled including fibrin-based glues, 3 pressure garments, and local application of corticosteroids 4 and sclerosants such as erythromycin. 5 None eliminate occurrence conclusively.Our method for drainage avoids the need for awkward syringe aspiration, which can be time consuming and uncomfortable for the patient. The technique is versatile and can also be used for other procedures such as conservative aspiration of a large scrotal hydrocoele. High success rates have resulted in the technique of anastomosis remaining largely unchanged since this time. Here we describe a refinement on this technique that optimises venous length and helps prevent kinking of the draining AV fistula vein. TECHNIQUE Often the vein and artery are closely related, allowing side-to-side anastomosis or end-to-side anastomosis with a chamfered vein. In some instances there is a significant distance between artery and vein, especially in the antecubital fossa, when an almost 90º AV anastomosis may be required. In this situation maintenance of venous length is pivotal to avoid anastomotic tension and twisting that may preclude fistula maturation.

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Concepts of Seroma Formation and Prevention in Breast Cancer Surgery

Cited by 179 publications

References 90 publications

Prevention of seroma formation after axillary dissection in breast cancer: A systematic review

Prevention of seroma formation after axillary dissection in breast cancer: A systematic review

Computer Simulation of Pectoralis Major Muscle Strain to Guide Exercise Protocols for Patients After Breast Cancer Surgery

Vacuum-assisted sterile drainage of large post-operative seromas: the Royal Marsden technique

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