What is a seroma?

What is a Seroma?

A seroma is a collection of serous fluid that accumulates beneath the skin, typically occurring as a postoperative complication when surgical procedures create an empty cavity or dead space for fluid to accumulate. 1

Characteristics of Seromas

• Definition: Seromas are characterized by the accumulation of clear, serous fluid in a pocket formed after surgery where tissue has been removed or separated 2, 1
• Composition: The fluid consists primarily of serum (the clear portion of blood) that leaks from damaged blood and lymphatic vessels
• Timing: Most seromas develop within one week after surgery, though some may appear later as "delayed seromas" 1
• Duration: Typically resolve within 1-3 months but can persist for up to 6 months or longer in some cases 3

Common Locations and Associated Procedures

Seromas commonly occur following:

• Breast surgery (mastectomy, breast reconstruction, axillary surgery) 4, 5
• Abdominal surgery 2
• Surgical drain removal sites 2
• Full-thickness skin graft donor sites 1
• Areas where tissue has been extensively undermined or dissected

Risk Factors for Seroma Formation

Several factors increase the likelihood of seroma development:

• Patient factors:

  • Higher body mass index (BMI) 5, 6
  • Larger breast size (in breast procedures) 6
  • Smoking 7
  • Diabetes mellitus 2

• Surgical factors:

  • Use of electrocautery for dissection 5
  • Extensive tissue dissection 2
  • Use of acellular dermal matrices in breast reconstruction 2, 3
  • Use of synthetic meshes in breast reconstruction 7
  • Lymph node surgery 6

Clinical Significance and Complications

Seromas can lead to several complications if not properly managed:

• Delayed wound healing
• Increased risk of infection 2, 6
• Patient discomfort and pain
• Restriction of movement
• Potential delay in starting adjuvant therapies 4
• Implant loss in breast reconstruction cases 6, 7
• Formation of a fibrous capsule around persistent seromas

Management Approaches

Prevention Strategies

• Surgical technique:

  • Meticulous hemostasis during surgery 3
  • Quilting sutures to reduce dead space 4
  • Proper placement and management of surgical drains 2

• Drain management:

  • Placement of drains through subcutaneous tunnels 2
  • Removal when output is <30 ml daily or within 7-14 days 2
  • Avoiding very early drain removal (within 24 hours) 5

• Postoperative care:

  • Delayed shoulder physiotherapy after breast/axillary surgery 5
  • Early expansion of tissue expanders in breast reconstruction 2, 3

Treatment of Established Seromas

• Observation: For small, asymptomatic seromas that don't interfere with assessment 2

• Aspiration: First-line treatment for symptomatic seromas 6

  • Ultrasound-guided needle aspiration for larger or recurrent seromas
  • May require multiple sessions

• Surgical intervention: For persistent seromas with capsule formation or those not responding to aspiration

• Sclerosing agents: In cases of persistent lymphorrhea, solutions like Rifampin have been used to reduce drainage 7

When to Intervene

Intervention is generally indicated when seromas:

• Cause significant discomfort or pain
• Restrict movement or normal activity
• Show signs of infection
• Persist beyond 6 months despite conservative management 3
• Prevent necessary assessment of underlying structures 2

Seromas remain a common postoperative challenge despite advances in surgical techniques, with recurrent transcutaneous aspiration often being the most effective management strategy for established seromas 5.