Chronic Seroma – Breast Diagnosis and Treatment Options
Patients in my practice present with both acute and chronic seromas status post blunt trauma to the chest after a breast augmentation procedure. The seroma is simply a water serous fluid that the body creates after a tear in the capsule. Capsular tear may lead to this fluid accumulation which can differ in size, between medium and small seromas. Small seromas may resolve with a few weeks over time. Moderate to large seromas may however settle for several months and may require surgical intervention with exploration of the breast, evacuation of the seroma, antibiotic irrigation and possible JP drain placement, if necessary, due to inflammation of the pocket. Seromas can be found in any pocket, including breast augmentation, subpectoral or subglandular pockets, or an abdominoplasty cavity in which there is extensive dissection over the abdominal muscles leading to a large free space that can be filled with fluid. The diagnosis of a seroma is normally associated with an enlargement of the breast with fluid shifts within the breast itself. It can be diagnosed either clinically for large and medium size seromas or can be determined by ultrasound for smaller seromas. Seromas should be differentiated from hematomas which are often associated with ecchymosis and staining from hemosiderin deposition of the skin over time. The diagnosis of a seroma is also consistent with blunt trauma, including motor vehicle accidents or whiplash accidents from a seatbelt which leads to a tear of the capsule and serous fluid formation. Seromas that are not drained, over time may lead to capsular contracture with resorption of the serous fluid back into the capsule causing thickening, hardening and scar tissue formation. The treatment options for small seromas can include conservative management, ice compression, antibiotics, aspiration and compression garments, including the Dr. Linder Bra. Medium to large seromas should undergo, under general, exploration with possible drain placement if necessary.
|The video provided shows a patient status post motor vehicle accident with a 700 cc clear straw-colored seroma that was found under exploration of her breast under general anesthesia. Notably, she had scar tissue contracture along the medial breast requiring open periprosthetic capsulectomy. Implant was replaced after copious irrigation with antibiotic irrigant, including gentamicin and Bacitracin and a 7 mm JP drain was placed in order to reduce recurrence of serous fluid. It is controversial when not to place a Jackson-Pratt drain. Patients who have small seromas that do not show any further evidence of fluid accumulation or acute inflammation or bleeding do not always need a drain. Do remember that drains can be a portal for infection, staph, strep, MRSA, E-coli, pseudomonas and other types of bacterium, especially when a prosthetic device such as an implant is found within the breast cavity. Therefore, it is important to weight the risk of a drain with the risk of recurrence of fluid if there is active inflammation.|
In this patient specifically due to the scar tissue contracture and acute inflammatory response, JP drains were subsequently placed in the pockets. Seromas are very commonly associated with trauma. Trauma can be as simple as lying on her chest, lying on your side at night during sleep or a heavy workout with a tear in the capsule. It can also be associated with severe blunt trauma, including assault or a motor vehicle accident with seatbelt whiplash.
Board Certified Plastic and Reconstructive Surgeons are able to diagnose and treat these seromas accordingly.