Seroma After Breast Reconstruction With Tissue Expanders

Abstract

BackgroundSeroma is a relatively common complication after breast reconstruction with tissue expanders. The main risk in the presence of seroma is development of periprosthetic infection, which can lead to implant loss. Our goals were to identify risk factors for seroma, and to describe our protocol for managing fluid accumulation.Patients and MethodsAn IRB approved breast reconstruction database was reviewed to identify patients who underwent tissue expander reconstruction. Patient characteristics, details of surgery, outcomes and treatment were recorded.ResultsTwo hundred nineteen tissue expander reconstructions were performed in 138 patients. Twenty-eight reconstructions developed seroma (12.8%), and 75 were identified to have prolonged drains (34.2%). Seroma was more common in patients with lymph node surgery (P = 0.043), delayed reconstruction (P = 0.049), and prepectoral reconstruction (P = 0.002). Seroma and/or prolonged drains were more commonly noted in patients with higher body mass index (P = 0.044) and larger breast size (P = 0.001). Aspiration was the most common intervention (85.7%), which was performed in the clinic utilizing the expander port site. There was no difference in infection or explantation rate between seroma and no-seroma patients (P = 0.546 and 0.167), whereas patients with any fluid concern (seroma and/or prolonged drains) were more prone to developing infection and undergoing explantation (P = 0.041 and P < 0.005).ConclusionWe recommend that prolonged drain placement longer than 3 weeks should be avoided, and patients should be screened for fluid accumulation after drain removal. Serial aspiration via expander port site and continuation of expansion provide a safe and effective method to manage seromas to avoid infection and expander loss.

Comparing outcomes of prepectoral, partial muscle-splitting subpectoral, and dual-plane subpectoral direct-to-implant reconstruction: implant upward migration and the pectoralis muscle

“…Köpke et al noted that elderly patients with large breast volumes had an increased risk of seroma formation after mastectomy ( 29 ). In addition, Ozturk et al reported a seroma or prolonged drain after breast reconstruction with a tissue expander in patients with larger breasts ( 30 ). Not only the size of the breast but also the dimensions of the ADM can be risk factors for seroma formation.…”

“…Not only the size of the breast but also the dimensions of the ADM can be risk factors for seroma formation. When ADM ingrowth into a patient’s tissue is insufficient, it may produce fluid that can inhibit wound healing and create additional body fluid ( 30 ). Because prepectoral and partial muscle splitting subpectoral reconstruction use a larger surface area of ADM, it can cause more seroma.…”