The Progression Of Seroma To Prosthesis Failure In Breast Reconstruction: An Analysis Of Temporal Relationships
Sumanas Jordan, MD, PhD, Sujata Saha, BS, Francis Lovecchio, BS, Neil A. Fine, MD, John YS Kim, MD.
Northwestern University, Chicago, IL, USA.
Seroma after mastectomy with tissue expander reconstruction occurs frequently, yet its role in prosthesis failure may be under recognized. This study aims to define the temporal progression of seroma-related events and the impact of seroma on overall post-operative course.
A review of 1,605 consecutive breasts undergoing immediate tissue expander reconstruction between 2004-2013 was conducted. The impact of seroma on post-operative outcomes was examined, and the timecourse of seroma-related events was tracked.
Overall seroma rate was 2.99%. Seroma was associated with a higher rate of overall complications (39.6% vs. 15.4%, p<0.001), infection (18.8% vs. 4.4%, p<0.001), mastectomy flap necrosis (22.9% vs. 7.4%, p<0.001), and prosthesis loss (22.9% vs. 5.8%, p<0.001). Seroma increased the likelihood of additional complications (OR 2.81, 95%CI 1.40-5.61; p=0.003), infection (OR 4.01, 95%CI 1.66-9.69; p=0.002), infection resulting in expander loss (OR 6.71, 95%CI 2.41-18.68; p<0.001), and expander removal due to any complication (OR 4.42, 95%CI 1.92-10.16; p<0.001). Seroma preceded infection and prosthetic loss in all cases by an average of 9.8 and 15.9-days, respectively.
We have demonstrated a deleterious progression of seroma to prosthetic failure. Nearly 1 in 5 patients with seroma developed an infection, and seroma with concomitant infection increased the risk of prosthetic loss by 6.7-fold. This study highlights the importance of strategies to better manage dead space and early aggressive intervention when seroma does occur.
Back to 2015 Annual Meeting Posters