Prevalence, risk factors, and management of seroma formation after breast approach endoscopic thyroidectomy

Breast approach endoscopic thyroidectomy (BAET) allows surgeons to remove a thyroid tumor from a remote site while providing a scarless cosmetic appearance in the neck. However, seroma formation after subcutaneous dissection could lead to flap detachment, incision dehiscence, and wound infection. Chronic formation of seromas could substantially compromise the esthetic outcome of BAET. We evaluated the prevalence, risk factors, and treatments of seroma after BAET.

A total of 344 patients who underwent BAET between 2001 and 2008 at our institution were recruited; data were collected prospectively. The characteristics and outcomes of patients who developed seromas were compared with those of patients who did not. Regression analysis was used to identify the independent risk factors for seroma formation. The frequency and volume of aspirations were noted until the seroma went into remission.

The overall postoperative prevalence of seroma formation was 2.9%. There was a significant difference in seroma formation based on age, hypertension, body mass index (BMI), and area of subcutaneous dissection space (ASDS). Percutaneous aspiration alone or combined with external compression was extremely effective. The frequency and total volume of aspirations were 1-7 and 6-120 ml, respectively. As a result of prolonged seroma formation, one patient developed an expanding pseudo-bursa that created a tumor-like effect in the anterior chest wall.

Seroma formation was an uncommon minor complication after BAET. Four independent etiologic factors could predispose patients to postoperative seroma formation. Percutaneous aspiration appeared to be very effective. Prolonged seroma formation followed by development of a pseudo-bursa could be very problematic and could substantially impair the esthetic effect of BAET.