Timing of Seroma Formation After Lumpectomy
Seromas typically develop within the first week following lumpectomy and are one of the most common post-operative complications of breast surgery. 1
Timing of Seroma Development
- Seromas generally form in the immediate postoperative period (within the first week) following breast surgery 1, 2
- They result from accumulation of serous fluid in the dead space created by surgical removal of breast tissue 2
- Seromas are considered a consequence of prolonged lymphorrhea after breast tissue removal 3
Risk Factors for Seroma Formation
Several factors increase the likelihood of seroma development after breast surgery:
- Higher body mass index (BMI) and larger breast size 4, 5
- Age over 45 years 5
- Hypertension 5
- Total drainage output exceeding 500 ml in the first three postoperative days 5
- Use of electrocautery for dissection 2
- Use of acellular dermal matrices in reconstruction cases 1
- Lymph node surgery 4
Clinical Presentation and Detection
- Seromas present as fluid collections beneath skin flaps or in the surgical dead space 2
- They may cause breast swelling, asymmetry, or a sensation of fullness 1
- Diagnosis is typically made clinically when a collection is detected beneath the skin flaps 5
- Ultrasound can confirm the presence and extent of seroma 3, 4
Management of Seromas
- Most seromas resolve spontaneously within a few weeks after surgery 6
- Persistent seromas may require aspiration, which is the most common intervention (performed in 85.7% of cases in one study) 4
- Recurrent transcutaneous aspiration remains the primary management approach for persistent seromas 2
- In rare cases of prolonged seromatous effusion with formation of thick-walled reservoirs, surgical resection may be necessary 6
Complications of Seromas
- Prolonged drainage is problematic as it increases infection risk 2
- Seromas can delay adjuvant therapy if they persist 2, 3
- In reconstruction cases, seromas increase the risk of implant loss 3, 4
- Large seromas may obscure small residual calcifications on post-operative mammograms 1
Prevention Strategies
- Meticulous hemostasis during surgery is critical 1
- Allowing the biopsy cavity to fill with serum rather than using drains in the breast 1
- Obliteration of dead space with flap fixation techniques 2
- Delayed shoulder physiotherapy in the immediate post-operative period 2
- Early drain removal (but not within 24 hours) may reduce seroma formation 2
- However, prolonged drain placement longer than 3 weeks should be avoided 4