Seroma After Breast Surgery

The seroma is a fluid-filled pocket that takes on the shape of a cyst or lump. The size of the lump can vary. Seromas usually form within the first week or two after surgery, but can also happen later on. Usually seromas are soft and moveable. They can also be tender to the touch and influence shoulder movement and strength depending on the size and severity of the seroma.

Their location is very close to multiple nerves and blood vessels that supply the shoulder and upper extremity. Often, they are oriented as a linear chain of lymph nodes, or as a chain that branches into two separate chains of lymph nodes.

Why Do Seromas Form?

Axillary node dissection is a surgical procedure in which axillary lymph nodes are removed. This is usually done as part of a mastectomy, lumpectomy or other breast cancer surgery. A sentinel lymph node biopsy may be done first to see if the axillary lymph nodes are affected by cancer. A special dye is used to locate the sentinel lymph node, which is the first lymph node to which the primary tumor drains. If additional nodes other than the sentinel node are involved, then an axillary node dissection will be performed. During an axillary node dissection, the surgeon will make an incision in the armpit and remove one or several axillary lymph nodes. This procedure is typically done under general anesthesia, and it usually takes 1-2 hours to complete. Recovery time varies depending on the individual, but most people feel well enough to return home the same day or within a few days. Axillary node dissection is a fairly common procedure, and it is generally considered to be safe and effective.

How Common are Seromas After Breast Cancer Surgery?

Seroma after breast cancer surgery can develop in anywhere from 3 to 85% of patients after mastectomy or axillary surgery. Incidence is related to surgical technique as well. One study of 359 patients has shown that seroma developed more often after modified radical mastectomy (19.9%) compared to breast conserving surgery (9.2%).

How Are Seromas Treated?

Treatment for seromas may involve draining the fluid using a needle or syringe or the application of pressure. In some cases, various types of surgery may be necessary to get rid of the dead space in the tissue. With proper treatment, seromas can usually be resolved without any long-term problems.

When swelling and or seroma after breast cancer surgery is present, referral to a skilled certified lymphedema therapist can be beneficial in providing gentle manual therapy to reduce swelling and pain, ease movement, and facilitate earlier body absorption of the uncomfortable lump in the breast or axilla. A certified lymphedema therapist or physical therapist skilled in oncology rehabilitation can also provide gentle compression recommendations to help you sleep better and move more easily. If you are wondering if lymphedema therapy or physical therapy can help you with your seroma, contact us here to talk to a certified lymphedema therapist or physical therapist knowledgeable in oncology rehabilitation.

Are Seromas a Type of Lymphedema?

Seromas are not a type of lymphedema but can be seen alongside of lymphedema. Lymphedema is a chronic, protein-based swelling that results from damage to the lymphatic system by factors like surgery, radiation, infection, or trauma. It generally diffusely affects the large area of a limb or section of the body, such as the entire leg, the arm, the breast, or the lower leg. There is a risk of developing lymphedema after breast cancer, for example when undergoing and after completing breast cancer treatment. On the other hand, seroma is a localized collection of fluid that develops after surgical procedure in the skin or under a skin flap, depending on the type of procedure and it is typically considered a temporary side effect of surgery.

Do Seromas Place you At Higher Risk for Lymphedema?

One study of a sample of 130 breast cancer patients revealed that patients who experienced symptomatic seroma had a 7.78 times the odds of developing arm swelling than those who did not. The study also found that the patients with symptomatic seroma had 10.64 greater odds of developing chest and arm swelling than those who did not have symptomatic seroma. They concluded that "symptomatic seroma is associated with increased risk of developing lymphedema symptoms following breast cancer treatment." They also concluded that patients who develop symptomatic seroma should be be considered higher risk and receive interventions to reduce the risk of developing lymphedema.

If you have a seroma after breast surgery, deBorja Physical Therapy in Baltimore, MD can help. Contact us so you can find out if you are a candidate to receive help based on your current medical history.

Sources:

Srivastava V, Basu S, Shukla VK. Seroma formation after breast cancer surgery: what we have learned in the last two decades. J Breast Cancer. 2012 Dec;15(4):373-80. doi: 10.4048/jbc.2012.15.4.373. Epub 2012 Dec 31. PMID: 23346164; PMCID: PMC3542843.

Fu MR, Guth AA, Cleland CM, Lima ED, Kayal M, Haber J, Gallup L, Axelrod D. The effects of symptomatic seroma on lymphedema symptoms following breast cancer treatment. Lymphology. 2011 Sep;44(3):134-43. PMID: 22165584.

Gonzalez EA, Saltzstein EC, Riedner CS, Nelson BK. Seroma formation following breast cancer surgery. Breast J. 2003 Sep-Oct;9(5):385-8. doi: 10.1046/j.1524-4741.2003.09504.x. PMID: 12968958.

Dr. Angie deBorja is a Doctor of Physical Therapy and founder of deBorja Physical Therapy in Baltimore. She has been helping patients since 2001. Her clinic specializes in helping adults 40+ in Baltimore, MD after cancer treatment, surgery, and injury, with a gentle approach to overcome pain and stiffness, move better, and get back to the active life they once enjoyed.