We looked at the pre and post-operative assessment of seromas after breast reconstruction in a previous blog and video. Here, Drs. Minas Chrysopoulo and Ramon Garza III of PRMA in San Antonio explain to the viewer how to evaluate and treat a seroma if it occurs after breast reconstruction.
Seromas form because of your body’s natural healing processes. Think of a wound you get on the outside of your body. The body produces fluid as part of the healing process. You see fluid as with a scraped knee or a burn. Imagine the wound on the inside of your body that forms because of surgery. Your body is going to produce fluid internally due to the trauma of surgery. This fluid must be managed.
Dr. C, as his patients refer to him, explains a seroma can happen anywhere someone has surgery. In breast reconstruction this can be in the breast area alone if it is for implant-based breast reconstruction. If you are having tissue breast reconstruction you can get a seroma anywhere the tissue comes from, for example, the tummy if you’re having DIEP flap surgery.
Many, but not all surgeons use drains to help manage this fluid post-surgery. Drains are put in place at the time of surgery. They are used to suck out the fluid that develops. Although not a favorite part of breast reconstruction for many patients, I always mention, drains are temporary.
Dr. C explains there is set criterion used to determine when the drains can be removed. Unfortunately, there are instances when fluid continues to form in some patients even after the drains are removed. It can become very uncomfortable and a problem for those who experience this. Fluid buildup after surgical drains are removed should be reported immediately to your plastic surgeon.
When these seromas form they can be treated. Here is a list of what Dr. C says can be done.
- Placing a syringe through the skin and sucking out the fluid.
- Putting more compression over the area to help things stick.
- Substances can be injected into the space to help it stick down or sclerose.
- Sometimes a drain must go back in to help with the fluid absorption.
- In rare instances, a cavity on the inside may develop and must be dealt with at the next phase of surgery.
I asked Dr. Garza what the fluid looks like if a bit of seepage occurs and a patient notices. Dr. Garza explains the fluid will have a bit of yellow tinge to it. A patient sometimes mistakes this for puss or an infection. He explains this is the normal color of plasma, which is essentially what seroma fluid is like. It contains proteins, white blood cells, and things normally found in the blood stream minus the red blood cells.
You may notice staining on the gauze placed after surgery or some crust forming around the drain areas. It is not an infection. Signs of an infection might include the following:
- Spreading redness around the area of the skin.
- Puss coming out of the wound which is a very milky consistency. Seroma fluid is mostly clear.
- A fever and/or general feeling of illness.
- Increasing tenderness or pain.
Dr. C adds, if a patient notices an area getting larger when they have a drain, this is cause for concern and you should call your plastic surgeon. It could mean the drains have stopped working. This can happen for a variety of reason; movement or perhaps the drain might get pulled out a bit.
Watch and listen to the video for a great explanation from these two, board certified plastic surgeons. You can sign up to view more educational videos on topics related to breast reconstruction after you view the YouTube video.
Terri, thank you for this informative article. I had the drains, which, frankly, sucked, although I know they helped me. And you are right: they are temporary. It’s hard to see that when you’re in the midst of it, but they are temporary. Thank you!
You are most welcome, Beth! Yes, no one likes those drains. Did you read my funny blog post on “Surgical Drains”? Sometimes we just have to grit out teeth to get through breast reconstruction recovery. Always love hearing from you Beth. ~ Terri