Seroma is an abnormal accumulation of serous fluid which sometimes develops after a surgery. It is especially common after large dissections, such as mastectomy or breast augmentation, abdominoplasties and body or face lifts. Usually, seroma resolves itself within a few weeks. However, fluid accumulation stretches the skin and causes it to sag, this causes discomfort and anxiety together with prolonged recovery, longer hospital stay, more frequent office visits and over-stretched health budget. Different factors influence the formation of seroma but their role in pathogenesis varies in each patient. To prevent and manage seroma formation, it is very important to understand how it emerges.
The pathophysiology of seroma formation is not fully understood but lymph vessel spillage is supposedly the main cause of accumulation of the lymphatic fluid. However, it is also thought that seroma is more than a mere accumulation of serum. It is probably formed by an acute inflammatory exudation. During the operation, the surrounding tissues, blood vessels and lymphatic vessels are traumatized. As a reaction to trauma, inflammation emerges in the surgical site. In other words, the body floods with lymph causing pain and swelling that occur after a surgery. Sometimes, because ducts get traumatized, the lymph, instead of naturally draining away, accumulates, and this leads to the formation of seroma.
Patients should be aware of the possibility of seroma formation. They are usually encouraged to monitor the surgical site for abnormalities and complications. Although seroma is not very dangerous, it can lead to serious complications such as skin flap necrosis, delayed wound healing, infection, predisposes to sepsis and lymphedema. Seroma formation may also be affected by factors such as age, weight, diabetes and hypertension.
Abdominoplasty is one of the procedures after which seroma may occur. According to studies, incidences of seroma after abdominoplasty range from 5% to 50%. Also it has been noticed, that some patients are more prone to develop this complication. It may happen because of wider incision of the abdominal skin and the disruption of vascular and lymphatic channels.
Mastectomy is another surgery after which seroma may emerge. The incidence rate is between 15% and 81%. The most significant influencing factors of seroma in breast surgery are the number and the extent of the axillary lymph node involvement. Wide dissection in mastectomy and axillary lymphadenectomy damages several blood vessels and lymphatics and leads to seroma. Sometimes, after mastectomy, patients are willing to have reconstructive breast surgery and thelatissimus dorsi flap surgery is among the first choices. However, according to the study that examined patiens who had latissimus dorsi flap breast reconstruction from 1998 to 2003, 47 % of them had seroma.
A large number of surgical methods and techniques have been performed to reduce seroma formation. Small seromas, often unnoticeable, resolve on their own, although left untreated, they can calcify forming solid knots. Larger seromas often require repeat needle aspiration, whereas intractable seromas may require drain replacement. Seromas that become infected may require antibiotic therapy and, on rare occasions, surgery. However, prevention seems to be the best treatment of seroma and drainage is one of the most accepted and universal methods of prevention. Short use of the drainage system reduces or even prevents seroma incidence compared to no drainage at all. Compression dressing to prevent seroma rate is also in use and it is a common method used by some surgeons.