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Seroma in Prosthetic Breast Reconstruction

Jordan, Sumanas W., M.D., Ph.D.; Khavanin, Nima, B.S.; Kim, John Y. S., M.D.

Plastic and Reconstructive Surgery: April 2016 - Volume 137 - Issue 4 - p 1104–1116
doi: 10.1097/01.prs.0000481102.24444.72
Breast: Special Topics
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Background: Seroma, as a complication of prosthetic breast reconstruction, results in patient distress, increased office visits, undesirable aesthetic outcomes, and—importantly—may escalate to infection and frank prosthesis loss. Herein, the authors review the pathophysiology and risk factors and attempt to collate published practices for avoidance and management of seroma.

Methods: A systematic literature review was performed using MEDLINE, Web of Science, Embase, and Cochrane Library for studies published between 2000 and January of 2015. Random-effects meta-analysis was used to estimate the overall pooled incidence of seroma and to examine the effect of drain number and acellular dermal matrix use.

Results: Seventy-two relevant primary articles and three systematic reviews were identified. Fifty-one citations met inclusion criteria, including two randomized controlled trials. The overall pooled incidence was 5.4 percent (95 percent CI, 4.1 to 6.7 percent). Obesity, acellular dermal matrix, and preoperative irradiation were cited risk factors. Pooled relative risk for acellular dermal matrix was 1.83 (95 percent CI, 1.28 to 2.62). Drain practices were collated from 34 articles.

Conclusions: Seromas following prosthetic breast reconstruction are complicated by the hypovascular, proinflammatory milieu of the mastectomy skin flap, the geometrically complex dead space, and the presence of a foreign body with potential contamination and biofilm. There is reasonable evidence to suggest that these factors contribute to a progression of seroma to infection and prosthesis loss. These findings have motivated this summary article on current practice guidelines and strategies to prevent and treat seromas.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.

Chicago, Ill.

From the Division of Plastic and Reconstructive Surgery, Northwestern University, Feinberg School of Medicine.

Received for publication February 14, 2015; accepted November 17, 2015.

Disclosure:Dr. Kim is on the advisory board and receives research funding from the Musculoskeletal Transplant Foundation. The other authors have no relevant financial relationships to disclose.

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John Y. S. Kim, M.D., Division of Plastic and Reconstructive Surgery, Northwestern University, Feinberg School of Medicine, 675 North St. Clair Street, Galter Suite 19-250, Chicago, Ill. 60611, jokim@nm.org

©2016American Society of Plastic Surgeons