Concepts of seroma formation and prevention in breast cancer surgery.
BACKGROUND
Seroma formation is the commonest early sequel to breast cancer surgery especially when axillary dissection is undertaken. It is associated with significant morbidity and financial burden. The main pathophysiology of seroma is still poorly understood and remains controversial. The optimal ways to reduce the incidence of seroma formation are unknown. The aim of this paper is to review the concepts of pathophysiology of seroma formation following mastectomy and breast-conserving surgery for cancer. The various techniques in practice to reduce its incidence and treatment are outlined.


METHODS
MEDLINE search of published work on the subject with respect to its pathophysiology, prevention and treatment was carried out. Manual retrieval of relevant articles in the reference lists of the original papers from the MEDLINE was then carried out.


RESULTS
The pathophysiology and mechanism of seroma formation in breast cancer surgery remains controversial and not fully understood. Methods of prevention and treatment of seroma remain varied and inconclusive.


CONCLUSIONS
Evidence suggests an increase in the incidence of seroma because of thermal trauma from electrocautery dissection, but this is indispensable for surgical haemostasis. Obliteration of dead space by various flap apposition techniques has been shown to be advantageous in reducing incidence and volume of seroma. Low-pressure suction drainage reduces seroma volume and duration of drainage leading to earlier drain removal. Preventive measures have to be tailored according to individual patient and operative factors.
Agrawal
Amit
A
Professorial Unit of Surgery, Nottingham City Hospital, Nottingham, UK.
Ayantunde
Abraham Abiodun
AA
Cheung
Kwok Leung
KL
D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000150:complications* / Q000503:physiopathology / Q000601:surgery*; D004210:Dissection / Q000379:methods; D005081:Exercise Therapy; D005260:Female; D006801:Humans; D008408:Mastectomy / Q000009:adverse effects*; D015412:Mastectomy, Segmental / Q000009:adverse effects; D015282:Octreotide / Q000627:therapeutic use; D011183:Postoperative Complications / Q000517:prevention & control; D011312:Pressure; D049291:Seroma / Q000209:etiology / Q000503:physiopathology* / Q000517:prevention & control*; D012782:Shoulder
D018931:Antineoplastic Agents, Hormonal; D015282:Octreotide