I had a mastectomy/expander over 9 months ago. Detected skin breakdown, before radiation. After radiation, seroma developed & has been aspirated over 15 times by Dr. Had to have expander removed, & now seroma is draining through 2nd incision mark for past 4 months. Have to wear maxi pads 24 hrs a day as fluid never stops draining. Dr. has given me option to undergo surgery to remove scar tissue & hope that my body will begin to absorb or tram-flap reconstruction. Has any Dr dealt with this?
4 Month Old Seroma, Post Mastectomy-still Draining Through Incision, Have any Doctors Dealt WIth This Before?
Doctor Answers 6
Breast reconstruction with a DIEP flap
Three basic forms of breast reconstruction exist. You can use your own tissue, implants or a combination of the previous two techniques. Your own tissue can be used in the form of the DIEP flap, PAP flap, SGAP flap or fat grafting. Implants can be done in one stage or two stage. Two stage reconstructions are started by placing expanders at the time of mastectomy. Once they expanders are placed they are able to be inflated as determined by wound healing. The final time consists of combining any of the above techniques.
If you are interested in being seen in Austin please give us a call. I know this is a difficult time for you. The majority of my practice is devoted to reconstruction for women with breast cancer or who are BRCA+
4 Month Old Seroma, Post Mastectomy - still Draining Through Incision, Have any Doctors Dealt WIth This Before?
Fluid collections are not an uncommon issue in cases such as yours and are sometimes very troublesome. You may require surgical intervention to excise the seroma capsule and try and promote adherence of your overlying tissue back down to your chest wall, along with drains. Hopefully this will resolve the problem. I typically do not consider any definitive breast reconstruction until approximately 6 months post- radiation completion. You will likely need a flap, given your previous history of radiation to your chest, which should significantly ameliorate the issues caused by the radiation. Of which, a DIEP flap is an excellent option! First - your wound healing issue, and or infection, must be controlled first. Hope that this helps and best wishes!
After the skin has radiation, healing is frustrating because the skin is just not as strong as it was before. Discuss this with your surgeon and explore your other options. Perhaps surgery to remove scar tissue is your best option.
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Chronic seroma after radiation.
Chronic seromas following radiation in the setting of an expander do occur. Unfortunately, due to the radiation, they usually do not resolve on their own. Attempts at scar revision and suction drainage can be successful, but the more reliable option is to bring in non-radiated vascularized issue from either a TRAM flap or a latissimus flap. If the skin is thin (and usually is), the vascularized tissue can help salvage this skin and improve the overall cosmetic result of the reconstruction.
Post mastectomy chronic seroma cavity needs to be surgically removed.
Unfortunately this will not go away on its own. It sounds like the lining of the seroma cavity needs to be removed with an operation, and then one or two suction drains inserted and left in for about two weeks. The suction from the drain collapses the cavity, and usually gets it to seal shut.
Once that is all done, you probably should have a flap reconstruction using your own abdominal fat.
Seroma formation is common, especially after radiation therapy. If you have chronic drainage the the capsule should be removed, as your surgeon has proposed, drain the wound and keep the drain till drainage is down to 15-20 cc per day.
Of course the removal of the capsule in the radiated area carries the risk of skin not healing well because of the radiation. There is also higher risk of infection.
Discuss all this with your plastic surgeon and then you can make an informed decision.
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