Post-mastectomy seroma: a new look into the aetiology of an old problem

Postmastectomy seroma (PMS) remains an unresolved quandary as the risk factors for its formation have still not been identified. Sixty-four consecutive female patients undergoing Halsted mastectomy were prospectively studied for this purpose. The risk factors that were studied included age and weight, diabetes, hypertension, tumour (size and location) and nodal (positive or negative) status and the use of perioperative blood transfusion. Additionally, the effect of PMS on total hospital drainage (THD), post-operative hospital stay and other wound-related complications were assessed. The incidence of PMS in this study was 28%, and those patients with PMS were designated as group A while the remaining patients were designated as group B. Group A patients were significantly older (P < 0.02) and heavier (P < 0.05) than group B patients; also, there were significantly (P < 0.0001) greater number of hypertensive patients in group A than in group B. In terms of other risk factors the two groups were statistically similar. Group A patients had significantly greater (P < 0.01) amount of THD than group B patients. Although no septic complications were observed as a result of seroma, its presence significantly (P < 0.0001) lengthened the post-operative hospital stay in group A patients. It is concluded that (1) PMS is a common problem, (2) its occurrence significantly increases the post-operative hospital stay, and (3) hypertension is perhaps the most important risk factor for its causation. Hypertension contributes to seroma formation, probably by way of prolonged oozing from the large mastectomy wound.(ABSTRACT TRUNCATED AT 250 WORDS)