Techniques in the Prevention and Management of Seromas After Breast Surgery

Abstract

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.

Increasing the incidence of drain‐free day‐case mastectomies with the use of a fibrin tissue sealant; data from a single surgical center in the United Kingdom

“…2 The most frequently employed technique to prevent seroma formation and its complications is to use closed suction drainage in situ. 3 However, evidence that using drains after breast surgery reduces infection, seroma, and hematoma formation is inconsistent. 4 An alternative approach is to reduce the dead space of the cavity.…”

Tumescent Anesthesia in Skin- and Nipple-sparing Mastectomy: Results of a Prospective Clinical Study

“…Regarding the use of electrocautery alone, it reduces the intraoperative blood loss per se, but increases the operative time of mastectomy compared to knife or scissor dissection, and may also lead to wider skin necrosis due to its direct thermal damage; conversely, TA may reduce thermodispersion of electrocauterization with fewer skin and subcutaneous ischemic lesions, thus achieving not only shorter time of operation but also less incidence and volume of seroma (19,20). However, the compressive effect on subcutaneous tissues and the vasoconstrictor effect of epinephrine, especially in combination with higher initial tissue expander volume for immediate reconstruction, could potentially contribute to skin-flap ischemia (8).…”

Digital Mammographic Features of Breast Cancer Recurrences and Benign Lesions Mimicking Malignancy Following Breast-Conserving Surgery and Radiation Therapy

“…SEROMA Seroma is a serous fluid collection within the breast parenchyma after BCS [38] seen in the early period. The etiology is suggested to be multifactorial, including surgically-created dead spaces, extended axillary surgery, disorder of lymphatic and vascular flows, and delayed wound healing [39,40]. Seroma occurs in 9-15% of patients after BCS with RT [41,42].…”