Is a Seroma the "Kiss of Death" in Prepectoral Tissue Expander Reconstruction?

A seroma following prepectoral tissue expander (TE) reconstruction often begets other complications, which may compromise the reconstruction. This study investigated the association between seroma and subsequent complications.

All consecutive prepectoral TE reconstructions performed between March 2017 and December 2022 at a single center were reviewed. Demographics, operative characteristics, and complications data were extracted for all patients and analyzed.

Two hundred patients (318 breasts) underwent reconstruction and were, on average, 53 years of age, nonsmokers (98%), and nondiabetic (91%), with a body mass index of 26 kg/m². Seventy-six (24%) breasts were radiated, and 93 (47%) patients received chemotherapy. All 318 breasts underwent immediate reconstruction following prophylactic (34%) or therapeutic (66%) mastectomies. Seroma occurred in 50 (16%) breasts and was associated with higher body mass index (30 versus 27 kg/m², P < 0.05) and higher mastectomy weight (662 versus 515 g, P < 0.05). Half of all breasts with a seroma (24 of 50, 49%) went on to develop other complications. Infection and explantation commonly followed, occurring in 18 (36%) and 21 (42%) breasts with a prior seroma, respectively. In adjusted multivariable models, prior seroma was associated with 9 times higher odds of infection (odds ratio 9.2; 95% confidence interval, 4-21, P < 0.01) and 7 times higher odds of explantation (odds ratio 6.8, 95% confidence interval, 3-17, P < 0.01).

Although causality cannot be determined, our data suggests that seroma may be the "kiss of death" in prepectoral TE reconstruction because half of all breasts with a seroma went on to develop other complications.