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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.

PURPOSE:
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.
METHODS:
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.
RESULTS:
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.
CONCLUSIONS:
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.


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