Guidelines for Complications of Cancer Treatment Vol VIII Part B

promises to reduce this risk of seroma by limiting the axillarydissection.In the immediate postoperative period this seroma is takencare of by a closed suction drainage which is left in for a periodof 10-12 days. After this, the drain is taken out and continuedseroma is managed by a simple percutaneous needle aspirationusing a wide bore needle (mostly an 18 G) with a 20 c.c.disposable syringe under strict asepsis. Usually due to theinsensate flaps after axillary dissection, this procedure is anabsolutely painless procedure. Seroma prevents themastectomy flaps from adhering to the chest wall and impairsthe healing process. In addition, the use of external breastprosthesis is also difficult in presence of excessive seroma.However, seroma is advantageous after a breast conservationsurgery as it helps in reforming the breast contour by fillingup the lumpectomy cavity and helps improve cosmesis.Generally, the seroma lasts for 4-6 weeks with gradualreduction in the volume collecting, and dries up nearlycompletely with gradual obliteration of the open lymphaticchannels with setting in of fibrosis. Persistent seroma and largevolumes of aspirations are noted mainly in women with ahigher body mass (obesity) [14].Various methods have been suggested and tested for reducingpostoperative seroma. Such as shortening the duration ofclosed low-pressure suction drainage (from 2 weeks to 2 days)[15]. There was no difference in infection rates andlymphoedema. But the duration of seroma aspiration increasedwith shorter durations of drainage (73% with 10-day axillarydrain; 86% with 2-days axillary drainage; and 97% where nodrain was used).Compression and strapping of axilla and chest wall [16,17]and even suturing of flap to muscle to reduce dead space [18]have been suggested as methods for reducing seroma.Reducing shoulder movements also appear to reduce6