Seroma is a pocket of clear fluid which sometimes develops following a surgery.
Seromas are very common after breast cancer surgical treatments, and also axillary surgeries if there has been metastasis and lymph node involvement.
- They can also occur after breast reduction surgery
- Breast augmentation surgery (breast implant)
- Breast reconstruction surgery
- breast biopsy surgery
- Plastic surgery
- Plastic reconstructive surgery
- Any other surgery in any part of the body including liposuction and body contouring surgeries.
A seroma may show on follow-up imaging studies after treatment of seroma (possibly causing some initial concern about a developing ‘lesion’), but more commonly they are quite visible and palpable.
Seromas are completely unrelated to ‘cancer cells’ and of no increased risk or concern whatsoever. But, they can complicate and extend the recovery period as the serous fluid needs to be drained.
Seromas may also increase the likelihood of ‘surgical site
seroma infection‘ (SSI) , so they do have to be treated and monitored. Seromas are not unique to the breast, but can develop anywhere in the body after any trauma or surgery. They are also seen following radiation therapy.
What causes a seroma?
There are a couple of different ways a seroma could form. Blood is essentially made from a combination of serum (which is part of the blood plasme and is liquid) and red blood cells. Sometimes the red blood cells ‘settle’ downward, causing separation from the serum. The serum then collects into a ‘seroma’.
Another way seromas can develop is from ‘leaky’ blood vessels. If there is a tiny tear in the lining of a blood vessel or capillary, this can allow the serum to escape, but not the red blood cells. Dying or injured cells can also trigger the inflammatory process which can contribute to the accumulation of serum fluid.
Seromas often ‘remain’ following a breast hematoma
Seromas are different from breast hematomas, which contains red blood cells, and breast abscesses, which contain pus and are the result of an an infected seroma. However, sometimes a seroma can ‘remain’ following the development of a
hematoma or seroma. The ultrasound image above is likely one of these ‘remnant’ seromas following a hematoma.
How common is a seroma following breast cancer treatment?
There is considerable difference of opinion as to the rate of seroma development, and even more confusion regarding the possible factors, whether treatment parameters or patient characteristics, that might predispose a woman to developing a seroma post surgery. From the available data, one might suggest the overall likelihood of developing a seroma following breast cancer surgical treatment is between 16% and 35%, so, maybe 1 out of every 4 women or thereabouts. There is really no way to predict this, and the only consistent factor influencing the likelihood of seroma seems to be the extent of the surgery.
Factors supposed to influence likelihood of developing a seroma following breast cancer surgical treatments
Many different ideas have been tested to see if they influence the probability of seroma development. While many studies claim to have evidence of increased risk factors in so many different aspects of breast cancer treatment, the only factor which seems to have a consistent and verified bearing on developing a seroma, is the extent of the surgery. A woman who undergoes a modified radical mastectomy (MRM or removal or breast) is thought to be about 2-3 times more likely to develop a seroma than a woman who’s breast cancer is treated with breast conserving surgery (BCS), and this seems logical.
Other suggested factors for seroma development: unproven
Many ideas that have been considered as risk factors for developing seroma, from just about every conceivable aspect of the procedure and the patient. Some studies have looked at factors of the blood; anemia, blood transfusion and blood loss during surgery. Others have considered technical aspects of the surgery itself. These include: the kind of scalpel used, the angle of incision, the type of anesthestic used, various aspects of suturing and latissimus dorsi flaps, the use of ‘adhesive glues’, the type and pressure of dressing used, whether the area is immobilized and the amount of time before immobilization is removed (for shoulder surgeries), the length of the operation, the type of seroma drainage (closed suction drain versus static drain, multiple channel vs. multiple holes), or the use of a fibrinolysis inhibitor.
Only the severity of breast surgery has a proven bearing on seroma development
Other studies regarding risk of seroma following breast cancer surgical treatment have looked at pre-existent conditions such as hypertension and diabetes mellitus, and any previous biopsies. Radiation treatment and neoadjuvant chemotherapy therapies have also been considered. Specific histological features including the size and grade of tumor, hormone receptor status, lymph node status ( positive or negative for breast cancer metastasis), number of lymph nodes removed (in axillary surgery) have also been considered. Some studies have even considered body-type and general health issues such as the size of the breasts, age, body weight, and smoking. Again, none of the above listed factors have been proven to have any consistent influence on risk of seroma, with the exception of severity of surgery. Modified Radical Mastectomy (MRM) versus Breast-conserving Surgery (BCS)
Treatments of seroma
Seromas will gradually be re-absorbed by the body, and most surgeons view them as an unavoidable nuisance rather than a serious complication. However, this can take many days or even weeks. Sometimes a ‘knot’ of calcified soft tissue remains after the seroma has dissipated. This calcification may show up on follow-up imaging studies, but is of no health concern whatsoever. However, sometimes the accumulation of fluid in a seroma can be excessive, causing the skin to stretch and to sag causing a skin flap. This can be uncomfortable for the patient and prolong the recovery time in hospital and the general healing process. In these situations the seroma might be drained by fine-needle aspiration, but this can take several attempts. In more serious cases, where there is wound dehiscence, it may be necessary for incision and drainage.
Seromas versus hematoma, is kind-of decided once you aspirate the fluid into a syringe, and see the color. If the fluid is yellow, call it a seroma. If very red, call it hematoma. In-between, call it whatever you want.
Yes, they gradually go away without aspiration. Yes, things get back to normal quicker if they are aspirated.
Q and A
- Where does seroma fluid come from? Sometimes it’s from a hematoma (bleeding) that separated into blood clots and yellow fluid (serum). Other times, it’s a leak of yellow fluid (lymphatic fluid) from the tissues, “just because”. Because why? I guess something made capillaries leaky. The capillary endothelial cells lining the blood vessels got sick. how?” Maybe during surgery, the tissues were compressed more than they liked, or their blood supply got a bit dampened.
- When will seroma go away? Eventually, or sooner if someone will agree to aspirate it. Does it come back? Yes, but usually much smaller the second time.
- How to avoid a seroma? I believe direct hand pressure on wounds is the best. I believe tissues wounded by surgery then stitched together, should not be massaged or pushed in different directions. You have to give time, for undisturbed cut tissue edges, to rejoin to each other otherwise there could be a problem on suture removal.
- Are seroma dangerous? No.
- Are seromas painful? Yes, often they stretch the surrounding tissue, stretching nerve endings, which send complaining signals to the brain, which the brain interprets as pain.
- Can Seromas be avoided? Seromas are less likely to occur if a small drain is placed at the wound site on surgery and removed when any fluid stops draining. However, seromas can still occur after drain removal.
- What are the signs and symptoms of seroma? Seroma symptoms include swelling at or near the wound site with leakage of clear or yellowish fluid. Sometimes this is accompanied by redness and mild pain (or tenderness) at the site. Seromas often appear like as a large lump or a large cyst. If a seroma is not regularly drained it can sometimes cause a hardened lump of scar tissue.
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