Seroma Production After Breast Cancer Surgery has a Pro-Inflammatory Component

Abstract

Seroma formation is the most prevalent postoperative sequela after breast cancer surgery. A total of 263 aspirations of seroma fluid in 42 patients were performed after mastectomy; cytokines were measured in 148 cases. The concentration of interleukin-1 (IL-1), interleukin-6 (IL-6), interleukin-8 (IL-8), interleukin-10 (IL-10), interleukin-12p70 (IL-12) and tumor necrosis factor (TNF) were measured. The patients underwent 9.0 seroma aspirations on average (range 1-17) during an average of 30.7 days (range 7-72). The average cumulative seroma volume was 2056.1 mL (range 50-5130). In all samples, the maximal average concentrations of IL-6 (mean 10717 pg/mL, range 136-100000) and IL-8 (mean 7221 pg/mL, range 102-79828) were 55-200-fold above the serum/plasma levels of asymptomatic adults. In contrast, we observed levels similar to normal serum/plasma levels for IL-1 (mean 62.8 pg/mL, range 0-1226), IL-10 (mean 29.8 pg/mL, range 3.6-359), and lower-than-normal serum/plasma levels of TNF (mean 3.4 pg/mL, range 0-31.7) and IL-12 (mean 0.5 pg/mL, range 0-11.8). Patients with clinical infection had generally significant higher maximal IL-6 (p = 0.004) and IL-8 (0.019) than patients without clinical infection. However, most patients had no bacterial infection. None of the cytokines were associated with cumulative seroma volume, duration of seroma production or number of seroma aspirations. Seroma formation after mastectomy has a pro-inflammatory component, as indicated by the high levels of interleukin-6 and interleukin-8. However, these levels do not predict the course of seroma production.

Daily Serum Collection after Acellular Dermal Matrix-Assisted Breast Reconstruction

“…In fact, the pathological origin of seromas has not been fully clarified, but has been found to be associated with several factors such as age, BMI, breast size [ 9 ], the type of surgical procedure [ 10 ], and the use of electrocautery [ 14 ]. However, several studies have demonstrated the inflammatory origin of the exudate; it seems likely to be the body's natural response to tissue damage [ 7 , 8 , 9 , 21 , 22 ]. Therefore, our Oncoplastic Breast Surgery Team decided to perform a conservative and delicate surgical technique aimed at reducing tissue trauma in hopes of attenuating the inflammatory response and reduce the variables related to serum production.…”

Bacterial colonization of seromas after breast cancer surgery with and without local steroid prophylaxis

“…Seroma formation has an acute inflammatory component in response to surgical trauma [3, 4] via the activities of proteinases, proteinase inhibitors, cytokines, and growth factors [5, 6]. In the early postoperative period, seroma fluid slowly becomes exudative with some characteristics similar to those of lymph [7].…”

Randomized clinical trial of prevention of seroma formation after mastectomy by local methylprednisolone injection

“…During the past decade, growing evidence has suggested that a seroma is more than the simple accumulation of serous fluid; rather, it is an exudate that forms in response to acute inflammation induced by surgical trauma. This concept is supported by the presence of proteinases, proteinase inhibitors and cytokines in the seroma fluid. Immunomodulatory compounds have been evaluated for the prevention of seroma formation, and have displayed some efficacy.…”

“…Chronic inflammation and proinflammatory cytokines, such as interleukin (IL) 1 and IL‐6, are considered to act as tumour promoters. Interestingly, high levels of the proinflammatory cytokines IL‐6 and IL‐8 have been detected in seroma fluid after breast cancer surgery. Postoperative administration of a steroid may exert an additional beneficial effect if tumour cells remain in the surgical field.…”

“…The mechanism underlying seroma formation remains controversial. Seromas were traditionally considered to be an accumulation of lymphatic fluid; however, it has been demonstrated that a seroma is an acute inflammatory exudate in response to the surgical trauma via the activities of proteinases, proteinase inhibitors, cytokines and growth factors. Quenching this inflammatory response by means of steroid administration has been performed for different types of operation, such as major abdominal surgery, colonic resection, head and neck surgery, plastic surgery and cardiac surgery.…”