Symptomatic Axillary Seroma after Sentinel Lymph Node Biopsy: Incidence and Treatment

Postoperative seroma is a nuisance for patients and surgeons. Few studies investigate predisposing factors for axillary seroma after sentinel lymph node biopsy (SLNB). We sought to quantitate the risk of symptomatic seroma and characterize interventions.

We performed a retrospective review of 667 women undergoing breast-conserving surgery and SLNB at our institution between July 2007 and January 2015. Surgeons dissected sharply or with standard electrocautery. We correlated patient and tumor characteristics with symptomatic seroma using logistic regression models for univariate and multivariate predictors. All statistical tests were two sided, with p < 0.05 considered significant.

Overall, 127 (19 %) of 667 women had axillary seromas and 98 (77 %) of 127 required further intervention for symptom relief. Seroma patients were similar in age, BMI, race, tumor type, T and N stage, and number of nodes removed as those without (all p > 0.07). Seroma rates did not vary according to surgeon, nodal mapping technique, or axillary closure technique (p = 0.8789). Multivariate analysis identified diabetes, smoking, and SSI as predictors of symptomatic axillary seroma with odds ratio of 1.97, 1.98, and 37.19 (all p < 0.017), respectively. Among the 98 of 127 patients with seroma, most (81 of 98, 83 %) resolved with a mean of 1.3 aspirations. The remainder resolved after axillary drain (13 of 98, 13 %) or additional surgery (4 of 98, 4 %).

Symptomatic axillary seroma occurs in 14 % patients undergoing breast-conserving surgery with SLNB and is not influenced by tumor, nodal mapping, or surgeon characteristics. Management infrequently requires more than simple aspiration. Drain placement at initial surgery may be considered in smokers or patients with diabetes.