Advertisement

Archives of Gynecology and Obstetrics

, Volume 298, Issue 5, pp 951–959 | Cite as

Seroma in breast surgery: all the surgeons fault?

  • Florian Ebner
  • Thomas W. P. Friedl
  • Amelie de Gregorio
  • Krisztian Lato
  • Inga Bekes
  • Wolfgang Janni
  • Nikolaus de Gregorio
Gynecologic Oncology
  • 116 Downloads

Abstract

Background

Despite a trend for less radical surgical approaches in breast cancer due to better understanding of tumour biology and new treatment options such as neoadjuvant chemotherapy (NAC) and intra-operative radiotherapy (IORT), seroma production remains one of the main surgical side effects that can result in prolonged recovery, delay of radiotherapy and patient discomfort. The aim of this study is to provide an update on risk factors for seroma production after breast cancer surgery considering the latest treatment options.

Methods

A retrospective analysis of seroma production in primary breast cancer patients treated between 01.01.2010 and 31.12.2014 at the Breast Cancer Centre, University Hospital Ulm, was performed. Patients with previous breast/axillary surgery or more than one intervention were excluded. Seroma formation was measured using wound drains placed in breast and axilla.

Results

In total, 581 patients met the inclusion criteria. Median age at diagnosis was 60 years, and median BMI 25.6 kg/m2. 60 (10.3%) patients had a mastectomy, 175 (30.1%) patients received IORT, and 72 (12.4%) patients received NAC. Median amount of seroma production was 82.5 ml (range 0–3012.5 ml). Multivariate analysis revealed that most of the observed variation in seroma production was due to type of surgery (mastectomy vs. breast conserving), length of surgery and number of removed lymph nodes. Both NAC and IORT explained a significant but very small amount of the observed variation in seroma production.

Conclusion

The most important factors for seroma production are extent and duration of breast surgery.

Keywords

Breast surgery Wound drainage Seroma Risk factors 

Notes

Authors contributions

FE: conceptualization, writing original draft, review and editing. TWPF: data curation, formal analysis. AG: resources. KL: supporting. IB: validation. WJ: supervision. NG: conceptualization, review and editing.

Funding

No external or additional funding was used for this study.

Compliance with ethical standards

Conflict of interest

All authors declare that they have no potential conflict of interest.

Ethical approval

This study was approved by the local ethic committee.

References

  1. 1.
    Veronesi U, Luini A, Galimberti V, Zurrida S (1991) Conservation approaches for the management of stage I/II carcinoma of the breast: Milan Cancer Institute trials. World J Surg 18(1):70–75CrossRefGoogle Scholar
  2. 2.
    Abt NB, Flores JM, Baltodano PA, Sarhane KA, Abreu FM, Cooney CM et al (2014) Neoadjuvant chemotherapy and short-term morbidity in patients undergoing mastectomy with and without breast reconstruction. JAMA Surg 149(10):1068–1076CrossRefPubMedCentralGoogle Scholar
  3. 3.
    Sedlmayer F, Sautter-Bihl M-L, Budach W, Dunst J, Fastner G, Feyer P et al (2013) DEGRO practical guidelines: radiotherapy of breast cancer I: radiotherapy following breast conserving therapy for invasive breast cancer. Strahlenther Onkol 189(10):825–833CrossRefPubMedCentralGoogle Scholar
  4. 4.
    Boostrom SY, Throckmorton AD, Boughey JC, Holifield AC, Zakaria S, Hoskin TL et al (2009) Incidence of clinically significant seroma after breast and axillary surgery. J Am Coll Surg 208(1):148–150CrossRefPubMedCentralGoogle Scholar
  5. 5.
    Silverstein MJ, Fastner G, Maluta S, Reitsamer R, Goer DA, Vicini F et al (2014) Intraoperative radiation therapy: a critical analysis of the ELIOT and TARGIT trials. Part 2–TARGIT. Ann Surg Oncol 21(12):3793–3799CrossRefPubMedCentralGoogle Scholar
  6. 6.
    Buchholz TA, Somerfield MR, Griggs JJ, El-Eid S, Hammond MEH, Lyman GH et al (2014) Margins for breast-conserving surgery with whole-breast irradiation in stage I and II invasive breast cancer: American Society of Clinical Oncology endorsement of the Society of Surgical Oncology/American Society for Radiation Oncology consensus guideline. J Clin Oncol 32(14):1502–1506CrossRefPubMedCentralGoogle Scholar
  7. 7.
    Kreienberg R, Kopp I, Albert U-S, Bartsch HH, Beckmann MW, Berg D et al (2012) Interdisziplinäre S3-Leitlinie und Nachsorge des Leitlinie. Ger Cancer Soc 2012(7):32–45Google Scholar
  8. 8.
    Srivastava V, Basu S, Shukla VK (2012) Seroma formation after breast cancer surgery: what we have learned in the last two decades. J Breast Cancer 15(4):373–380CrossRefPubMedCentralGoogle Scholar
  9. 9.
    Kuroi K, Shimozuma K, Taguchi T, Imai H, Yamashiro H, Ohsumi S et al (2006) Evidence-based risk factors for seroma formation in breast surgery. Jpn J Clin Oncol 36(4):197–206CrossRefPubMedCentralGoogle Scholar
  10. 10.
    Purushotham AD, Upponi S, Klevesath MB, Bobrow L, Millar K, Myles JP et al (2005) Morbidity after sentinel lymph node biopsy in primary breast cancer: results from a randomized controlled trial. J Clin Oncol 23(19):4312–4321CrossRefPubMedCentralGoogle Scholar
  11. 11.
    Ebner FK, Friedl TWP, Reich A, Janni W, Rempen A, Degregorio N et al (2013) Does non-placement of a drain in breast surgery increase the rate of complications and revisions? Geburtshilfe Frauenheilkd 73(11):1128–1134CrossRefPubMedCentralGoogle Scholar
  12. 12.
    Garbay J-R, Thoury A, Moinon E, Cavalcanti A, Di Palma M, Karsenti G et al (2012) Axillary padding without drainage after axillary lymphadenectomy—a prospective study of 299 patients with early breast cancer. Breast Care (Basel) 7(3):231–235CrossRefGoogle Scholar
  13. 13.
    Taylor JC, Rai S, Hoar F, Brown H, Vishwanath L (2013) Breast cancer surgery without suction drainage: the impact of adopting a “no drains” policy on symptomatic seroma formation rates. Eur J Surg Oncol 39:334–338CrossRefPubMedCentralGoogle Scholar
  14. 14.
    Thomson DR, Sadideen H, Furniss D (2013) Drainage tube placement after lymph gland removal from the armpit for breast cancer. Wiley, New YorkGoogle Scholar
  15. 15.
    Glechner A, Wöckel A, Gartlehner G, Thaler K, Strobelberger M, Griebler U et al (2013) Sentinel lymph node dissection only versus complete axillary lymph node dissection in early invasive breast cancer: a systematic review and meta-analysis. Eur J Cancer 49:812–825CrossRefPubMedCentralGoogle Scholar
  16. 16.
    Joyce DP, Manning A, Carter M, Hill ADK, Kell MR, Barry M (2015) Meta-analysis to determine the clinical impact of axillary lymph node dissection in the treatment of invasive breast cancer. Breast Cancer Res Treat 153:235–240CrossRefPubMedCentralGoogle Scholar
  17. 17.
    Shah-Khan M, Boughey JC (2012) Evolution of axillary nodal staging in breast cancer: clinical implications of the ACOSOG Z0011 trial. Cancer Control 19(4):267–276CrossRefPubMedCentralGoogle Scholar
  18. 18.
    Janni W, Kühn T, Schwentner L, Kreienberg R, Fehm T, Wöckel A (2014) Sentinel node biopsy and axillary dissection in breast cancer: the evidence and its limits. Dtsch Arztebl Int 111(14):244–249PubMedPubMedCentralGoogle Scholar
  19. 19.
    Ebner F, Wöckel A, Janni W, Kreienberg R, Schwentner L, Wischnewsky M (2017) Personalized axillary dissection: the number of excised lymph nodes of nodal-positive breast cancer patients has no significant impact on relapse-free and overall survival. J Cancer Res Clin Oncol 143:1823–1831CrossRefPubMedCentralGoogle Scholar
  20. 20.
    Balakrishnan A, Ravichandran D (2011) Early operable breast cancer in elderly women treated with an aromatase inhibitor letrozole as sole therapy. Br J Cancer 105(12):1825–1829CrossRefPubMedCentralGoogle Scholar
  21. 21.
    Hille U, Soergel P, Länger F, Schippert C, Makowski L, Hillemanns P (2002) Aromatase inhibitors as solely treatment in postmenopausal breast cancer patients. Breast J 18(2):145–150CrossRefGoogle Scholar
  22. 22.
    Hind D, Wyld L, Reed MW (2007) Surgery, with or without tamoxifen, vs tamoxifen alone for older women with operable breast cancer: Cochrane review. Br J Cancer 96(7):1025–1029CrossRefPubMedCentralGoogle Scholar
  23. 23.
    Headon H, Wazir U, Kasem A, Mokbel K (2016) Surgical treatment of the primary tumour improves the overall survival in patients with metastatic breast cancer: a systematic review and meta-analysis. Mol Clin Oncol 4(5):863–867CrossRefPubMedCentralGoogle Scholar
  24. 24.
    Cortadellas T, Córdoba O, Espinosa-Bravo M, Mendoza-Santin C, Rodríguez-Fernández J, Esgueva A et al (2011) Electrothermal bipolar vessel sealing system in axillary dissection: a prospective randomized clinical study. Int J Surg 9(8):636–640CrossRefPubMedCentralGoogle Scholar
  25. 25.
    Manouras A, Markogiannakis H, Genetzakis M, Filippakis GM, Lagoudianakis EE, Kafiri G et al (2008) Modified radical mastectomy with axillary dissection using the electrothermal bipolar vessel sealing system. Arch Surg. 143(6):575–580 (discussion 581) CrossRefPubMedCentralGoogle Scholar
  26. 26.
    Nespoli L, Antolini L, Stucchi C, Nespoli A, Valsecchi MG, Gianotti L (2012) Axillary lymphadenectomy for breast cancer. A randomized controlled trial comparing a bipolar vessel sealing system to the conventional technique. Breast 21(6):739–745CrossRefPubMedCentralGoogle Scholar
  27. 27.
    Canavese G, Catturich A, Vecchio C, Gipponi M, Tomei D, Sertoli MR et al (1997) Surgical complications related to peri-operative adjuvant chemotherapy in breast cancer. Results of a prospective, controlled, randomized clinical trial. Eur J Surg Oncol 23(1):10–12CrossRefPubMedCentralGoogle Scholar
  28. 28.
    Kraus-Tiefenbacher U, Welzel G, Brade J, Hermann B, Siebenlist K, Wasser KS et al (2010) Postoperative seroma formation after intraoperative radiotherapy using low-kilovoltage X-rays given during breast-conserving surgery. Int J Radiat Oncol Biol Phys 77(4):1140–1145CrossRefPubMedCentralGoogle Scholar
  29. 29.
    Tuschy B, Berlit S, Romero S, Sperk E, Wenz F, Kehl S et al (2013) Clinical aspects of intraoperative radiotherapy in early breast cancer: short-term complications after IORT in women treated with low energy X-rays. Radiat Oncol 8:95CrossRefPubMedCentralGoogle Scholar
  30. 30.
    Ebner F, Schramm A, Bottke D, Friedl TW, Wiegel T, Fink V et al (2016) Comparison of seroma production in breast conserving surgery with or without intraoperative radiotherapy as tumour bed boost. Arch Gynecol Obstet 294:861–866CrossRefPubMedCentralGoogle Scholar
  31. 31.
    Cracco S, Semprini G, Cattin F, Gregoraci G, Zeppieri M, Isola M et al (2015) Impact of intraoperative radiotherapy on cosmetic outcome and complications after oncoplastic breast surgery. Breast J 21(3):285–290CrossRefPubMedCentralGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Klinik für Frauenheilkunde und GeburtshilfeUniversität UlmUlmGermany

Personalised recommendations