Chronic Seroma anyone?

emor · January 2009

I had bilat mx on Aug 12 with TE. Mt drains were removed after 5 weeks. One side was fine, one was still draining 60 CC A a day. After 2 weeks I was back to the operating room. My breast looked like it had an infection but it was a seroma. A new drain was put in. After another week the incision opened - back to the OR. My PS did the same thing - took out the TE, cleaned scrubbed and put it back with a new drain. 8 weeks later, still draining 60 cc a day he decided after a long conversation with me to take the drain out to avoid infection. I was wrapped very tight at the chest and received truncal lymphedema treatment. 2 weeks later the scar of the drain started bubbling up. My PS took me back to the OR, opened it up and drained it, cleaned the scar tissue and closed it. Now 3 weeks later I am having the same thing again - drain scar is bubbling again at the same area and it was back to the OR last Thursday for another draining and repairing procedure. I have consulted another PS who said this will not get resolved by itself since my seroma is now chronic and the seroma pocket needs to be addressed by a surgical procedure to remove one layer of the pocket. Another option is to treat with tetracycline.

I am now 5 months post op, had several visits back to the OR and am very frustrated, I can't see the light at the end of the tunnel. was hoping to hear any feedback from anyone how had similar experience.

TammyLou · January 2009

I have not had that particular issue.

However, I have had problems with chronic wounds, and I know how demoralizing and frustrating it can be.

My sympathies.

Tammy Lou

rubytuesday · January 2009

I don't know if it will work or not but know that it works for drains initially....inactivity. The more 'sloth-like' you are the less you drain. At this point in time, with it appearing to be chronic, I don't know if it will work but I would give it a try. Have you tried any of the post-surgical supplements like bromelain & arnica?? If you google them, you'll find a lot of info. Sorry you are having to deal with this too. Best wishes

TenderIsOurMight · January 2009

Wow, you've had a tough go of it. I'm just wondering if a well done MRI of the area might help-don't know, but it surely does show the anatomy well. My thought is whether your PS may "see the problem architectually and be helped with its excision.

To help give you a mental image of a chronic seroma, a sipping straw has circumference and ends are somewhat similar in the sense the fluid collects within the open space and drains to the an opening. The goal is to excise the circumference of the involved damaged tissue so fresh new tissue can allow healing with closure of the space. I don't know about use of tetracycline. T.

baywatcher · January 2009

emor-

I've had a chronic seroma problem too but I didn't have recon. I have had seroma fluid drained about 10 times since my surgery on 10/8/08. My doctor thinks that he needs to open me back up and rough up the skin flap and put in a wick type drain to get the seroma to clear up. We plan to leave it alone for the time being and see if my body will absorb it within the next 3 weeks. It is very frustrating and I feel your pain.

2NewOnes · January 2009

My seroma problems became evident a couple months after my Stage 2 revisions last April. The right breast had to be drained three times and the left one once. Between June and Sept. they'd taken out almost 2 cups of fluid. I've been massaging this area outward to the side (as instructed) and I don't think it's accumulating any more but it doesn't feel like it's being absorbed very much. It's still too full on the sides, and too firm and misshapen along the incision line to have nipples done yet. I haven't been back since November and have put it off because there's such minimal improvement. I can't imagine how frustrating it must be for you! Please keep us posted on your situation.

sammyjo · January 2009

Emor, I really sympathise with you, like you I had my tissue expanders removed last week because of seroma in both sides. I had my initial surgery oct 11th 08, I had both drained weekly sometimes twice weekly, in the beginning by needle then my PS squeezed the fluid through the incisions, it was also draining constantly on its own, I was having to change my dressing up to 3 times a day. I did have necrosis which attributed to the poor wound healing. Having had the expanders removed my P.S is not overly concerned now and says its just a matter of time, I do hope this is true as I am still loosing a lot of fluid on a daily basis. My P.S said its because I had big breast which were very fatty and it is a reaction to the fat.

mom_of_2 · January 2009

My seroma was at the sentinel node dissection site. Surgeons drained 60-120cc twice a week for six wks to no avail. As soon as the lemon under my arm was flat it refilled before my eyes. Drs tried compression wear and manuel lymphodema drainage therapy. I believe the massage helped temporarily relieve pressure. I was eventually taken to o.r. for a surgical drain that I lived with for 3 wks and 5 days. Doctors attribute my seroma to beginning chemo 4 days after dissection. Chemo killed my healing ability. I finished chemo on Nov 4th and still needed seroma drained when I had bi lat w/ TE on Dec 17. I am worried about further fluid issues and don't really no what to look for in expander involvement. I feel pressure under both arms and worry it could be fluid. How will I know?

Mykidsmom · January 2009

Oh dear, that is so difficult. Just one thought, has anyone mentioned the possibility of a bleeding disorder? I have mild von Willibrandts (spelling?) and it resulted in massive bleeding after just an excisional biopsy. Anyhow, I received infusions of the factor prior to my BM w/ TE surgery and had very little drainage. I wonder if the two are related somewhat. Just a thought. Good luck. I hope this clears up soon. Take care. - Jean

emor · January 2009

Thank you all for your support and feedback. I have tried it all; total rest for 2 weeks (while I still had drains), lymphatic massage, compression, you name it. My blood chemistry is fine, nothing unusual. I will see my PS on Wed. I don't think there will be a change since I was just drained on Thursday. I will keep you all updated.

Erica3681 · February 2009

Hi emor,

Any update? Hope you've found a solution.

I had small seromas after bilateral mastectomies, too small for aspiration. In any case, my BS doesn't believe in aspirating unless the seroma is really painful, due to risk of infection. One side resolved on its own after about 4 weeks. The other side slowly resolved over six months, EXCEPT for one small area that still had fluid. About a year after that, I asked my physical therapist to use manual lymph drainage techniques to try to drain that little bit and instead more fluid developed. Still not very much, but upsetting to have things going in the wrong direction. Now the fluid seems to be thickening, not so "jiggly". It's just a small area, about 2 inches in diameter and only slightly raised, but I'd love to get rid of it--the area is the only numb spot left on my chest (I didn't have recon) and otherwise I've healed beautifully. It's now been 2 1/2 years since my surgery!

The last time I saw my breast surgeon (last June), she said a little fluid is normal and that it will eventually resolve, but I'm concerned that I'll be left with a raised hard area. This may sound weird to those who chose recon, but I actually like my otherwise smooth flat chest, just this one spot really bothers me. The next time I see my surgeon, I'll ask if anything can be done.

Just wondered if anyone out there has any suggestions. I'm reluctant to try a surgical fix, since it's not painful and doesn't affect my appearance in clothes, with breast forms. But I wondered about the idea of a course of antibiotics at this late stage. Someone above suggested tetracycline.

Barbara

DeniseH · February 2009

Hi, I feel for you, as I am going through the same thing. Had my bilateral mx Feb 2008, and the right side kept on filling up after the drains were removed. They drained it again after the port was installed. I was good for a while, then in Sept. after my radiation it looked like I was growing a new breast. CT scan was done and it was determined that it was a seroma, the size of a good implant. My doctor advised me to let it go and see if the body absorbs it. It never did, it became rock hard. Last week, 1 year after surgery, they removed the port and also removed what was now a chronic seroma, which had fused to the chest muscle. It was 10.5 x 4.5 x 3.5cm. The pathology report calls it a Fibrous Walled Cavity with Foci of Chronic Inflamation, Morphology consistent with a stated clinical diagnosis of seroma. Now I am back on a drain, and it still letting out 60cc a day. I am on Keflex for another week. My chest ist wrapped, and I feel like Deja Vu.

All I can say, keep an eye on it, after a while the body will not absorb any of this anymore. If it gets hard, it should be removed. Oh, I forgot to say, that I never had any kind of pain at the site.

Good luck, hope it all works out.

sherry123 · February 2009

Girls, I have never heard of seroma before. It sounds scary and its making me nervous. This is all relating to lymphedema? I'm sorry that all of you are going through this. Did you have lymphedema from the get go or did it develop over time? The swelling in my hand is spreading across my knuckles. i think i will travel tomorrow to my onco. instead of looking for a new one!. i wish you guys well. keep me posted.

DeniseH · February 2009

Sherry, the seroma is from the surgery where there is an empty cavity afterwards. With the mastectomy, when they take the breast of and suture the skin, behind this is where the seroma forms, it keeps weeping until that cavity is filled, therefore it can't heal. My left arm where they took out 16 lymph nodes is fine, never had any sign of swelling.

You should go see a doc about the swelling in your hand. Also, I would advice to meet with a lymphedema therapist, they can show you how to manually drain. It is very informative.

Good luck.

CAZ · February 2009

I'm 3 months post exchange surgery and had to mave a 250cc seroma sugically drained this week. It came on all of a sudden and was painful. They were expecting a hematoma. I was suprised that they didn't put me in a compression bra. The day after surgery it felt like it was filling again, so I put on the tightest sports bra I had and gently cool packed around the circumference of my breast. So far, so good. Although, I think there is some fluid making it feel a bit bigger and more firm.

I hope this resolves for both of you emor and Denise.

Carol(AZ)

SandyinSoCal · February 2009

I had a chronic seroma in my abdominal incision. It was present long enough that scar tissue began walling it off, at which point it becomes a pseudobursa. The pocket was draining mere drops per day through a small hole in my abdomen, so with a fluid-filled cavity, the walls never had a chance to seal together. Tetracycline can apparently make the inner linings stick to each other after the fluid is aspirated, but I've heard it is a very painful solution. Mine was surgically removed. I'm sorry you are going through this. Mine continued for four months, and I felt myself sliding into depression as the situation dragged on with no resolution. My original surgeon wouldn't touch it (he actually thought I was allergic to my sutures), so I had to find someone else to help me. That is how I ended up in New Orleans and completed my reconstruction there. The story has a happy ending though, because I ended up with a much better surgeon and therefore a much nicer result than I would have had otherwise.

emor · February 2009

MomsDaugther, this is so interesting to read especially today. I am still carrying a drain (now 6 1/2 months post op). My PS wants to keep waiting. I have decided to go see another PS this week who told me the TE must go out immediately and the wall of the seroma cavity removed. He said I can start over again about 6 weeks later. I am hoping my PS will agree to that since I really like him and trust him. The PS I saw was extremely arrogant and of course offered to do that but I did not really like him. He seems to have a lot of experience tough. Now I have to figure out how to approach my PS with this and hopefully I can get it done and keep on with my life. I am really tired of carrying this drain around and I have my down days too.

Binney4 · March 2009

Hi, Sherry,

A seroma is not lymphedema (thank goodness!) It's a pooling of fluid, a tiny pond, which is why it can be aspirated. The swelling of lymphedema is caused by fluid accumulation all over in among the cells, so it can't be aspirated, but a trained lymphedema therapist can do a gentle massage to stimulate the lymph system to remove it. Recent research indicates that a post-surgical seroma is an additional lymphedema risk factor, but it's not a guarantee of lymphedema. Smile

Lymphedema risk reduction tips here:

http://www.stepup-speakout.org/riskreduction_for_lymphedema.htm

Be well, all!
Binney

DATO · March 2009

I developed a seroma after my hysterectomy in late June 2007. I had a small incision, about 1 inch long at the bikini line. I was looking forward to getting the OK to swim at my 6 week check-up when the wound started leaking a small amount of fluid. The leaking was from a seroma. The seroma was a tunnel about 3.25 inches long between my skin/fat and the muscle. I went to the doctor's office every weekday to have it packed with a gauze-like tape. The tape was supposed to help with drainage and rough-up the skin in the tunnel so it would heal together and close. Over the top of the leaking wound I wore a sanitary napkin to absorb the drainage. After doing this for weeks with very slow progress the nurses asked me if I was eating well. I said yes because I wasn't eating junk food or soda. I was trying to lose the weight I had gained during chemo. I was having the seroma packed every weekday all through the summer and early fall (so much for swimming); it was getting smaller, but very slowly. Finally, the nurses asked me to tell them everything I ate on a typical day. I was having cereal for breakfast, carrot sticks for a mid-morning snack, a veggie sandwich for lunch, a piece of fruit for a mid-afternoon snack and some meat or fish with a starch and a veggie or salad for dinner. The nurses told me I wasn't eating nearly enough protein. I started eating eggs for breakfast and some protein for lunch and the seroma started healing faster. I don't know for sure if it was the added protein, or just the fact that after 5 months it started healing faster as it closed, but after I have my reconstruction (DIEP) one week from today, I'm going to be sure to eat lots of protein such as smoothies with whey protein powder. Good luck with your seroma.

conscorner · October 2009

Hi,

I'm very surprised to see so many women with this problem. I also have a seroma which developed about a year and a half after reconstructive surgery. It's along the scar on my back, where they used the lat muscle. I honestly didn't know what it was at first. A PT from work thought it may be a muscle. I finally went to my PS and he said it was a chronic seroma. It was drained in August and returned in October of this year. It took about 2 months to fill up again, but it came back bigger.

I just had it drained yesterday and I'm wearing my "girdle bra" again. He said I need an operation to remove the pocket that has formed. He will also put in a drain. Has anyone successfully gotten rid of a seroma by surgery? He said it will just continue to come back until something structural is done with the area. He also said that sometimes it is caused by pulling the drainage tube, which was in my back, from the first surgery. Sometimes the tube also pulls some of the tissue leaving a space. I'm just so surprised that I'm faced with this so long after the operation. I would welcome any feedback.

Conscorner

CoolBreeze · October 2009

I'm only 9 days out from mastectomy but I've developed a seroma too. (Had the drain out yesterday because it was clogged.) I was wrapped tight in compression bandages and with a foam core pressed up against my wound. I took a shower today and it's bigger, so it's not helping much.

I'm worried about my stiches as the area around them are all puffed up. I go back and see the doctor on Monday, we'll see if he drains it or not.

swimangel72 · November 2009

I had a seroma in my abdomen drained under ultrasound, because my PS was worried he might damage the mesh (that was put in place on July 10th to repair a large hernia). The radiologist drained about 75cc's then left a drain in place, which was removed a week later (just last week). I am wearing a tight Spanxx-like girdle every day and trying to take it easy. I believe my seroma formed because they removed the original drain tubes too soon - and because I became too active too quickly afterwards. My surgeons said I'd be fine returning to swimming just two days after the drains were removed, but I've come to realize that it takes MUCH longer for my body to heal. So - I'm praying this seroma doesn't return - and I'm really allowing myself to take it easy...........after doing light housework and some laundry today, I was a bit tired, so I feel no guilt at all laying in bed reading a book!

Jaimieh · November 2009

I am at the hospital now waiting to have a capsulectomy to remove all of the seroma's that I have formed over the last 10 mths.

Mykidsmom · November 2009

Best wishes Jaimieh!!!!!!!!!!!!!!!

rkt · November 2009

Dear Ladies,

I think this might be what I am battling! This coming Friday (Nov 6) will be six months since my mastectomy. Once drains were removed, I had to go to doctor's office once or twice a week to have fluid drained (towards the end, it was about 50 cc every week or so). I battled infection starting mid-July when I was undergoing radiation (not in breast, but UTI, went on antibiotics, developed both yeast infection and hives, was on antibiotics, steroids and antifungal all at same time. During this time (in July), I was drained one Monday, had a horrible night Monday night with pain throughout mastectomy site. Plus my mastectomy scar changed - it developed really hard ridges (about 1 inch thick), and skin pulled - whole scar sort of looked like a field that hasn't had any rain - lots of ruts and ridges. Pretty much stayed on antibiotics through August and September - had bout of cellulitis (according to PCP), lymphangitis (according to surgeon), finally was released from surgeon saying I didn't need to come back until December (no need to drain seroma anymore). 10 days later developed redness, warmth and pain across mastectomy site - diagnosed with abcess extending from sternum to underarm area - had to be surgically drained. Had vancomycin (IV) for three days in hospital, then went on Zyvox for 10 days, then bactrum for 7 (sinus infection). Surgery was a month ago today. Have been seeing surgeon once or twice throughout October. He released me (again) last Monday, said he would see me in February. I had been off of antibiotics 1 week. On Wednesday, redness, warmth and pain returned in area right next to sternum. So I am back on antibiotics, can push fluid around - still have three open incisions along my scar that are weeping. If you push on the ridges, they stay depressed (sort of like that foam everyone sleeps on, if you get the picture). Eventually pop back out.

So, is surgery the answer? I really don't want to have surgery again (twice already this year), but then again, school is over first week in December, don't have to go back until January, and have more than met out of pocket this year -

Any other ways that people have resolved the issue? I was reading about having alcohol or talc powder put into the cavity - I think they call is seromadesis? or having the inside surface of the seroma cavity removed - is that a capsulectomy?

Thanks in advance,

Becky

conscorner · November 2009

I am going to see my plastic surgeon on Monday to schedule an operation. I had the site drained on Thursday and it came back in just a few days. I believe it is called a capsulectomy. He said it would take about an hour, but I have to go under general anesthsia again. I'm not looking forward to another surgery, but I sincerely hope it works. If anyone has had success with the surgery I'd like to know. I feel that I must go through with this because the draining isn't working. The bump is quite large and can be seen through my clothes. I know that they use a different drain than the first time with the reconstruction using lat muscles. I hope that the surgery was successful for the person who posted. God bless!

Conscorner

bcrooks5 · February 2010

I am going through this exact same thing right now. I had my TE placed in Oct 09, implant exchange Nov 09, implant removed Jan 10, and just this morning it opened up again and started leaking. If you have had something that worked for you please tell me, I am going crazy with this! How long did it take for your seroma to finally heal?

rkt · February 2010

Dear bcrooks5,

I haven't had to see the surgeon since Nov 5 see my detailed message about my dealings with chronic seroma. The area has shown up as 'post-surgical fluid collection' on my scans since October surgery to clear the infection (PET in November, CT in February, with message that infection should be ruled out). So evidently there is still fluid there, but I haven't had any trouble with severe infection in the mastectomy scar area since November. This past Friday, I had cellulitis pop up again in right arm, and so am on antibiotics, so hopefully the infection won't spread to mastectomy scar. After the surgery beginning of October, it took almost two months for the three small incisions to heal from the inside out - I had to use saline to flush twice a day at first, then once they started to close, had to use peroxide twice a day to keep the incisions clean until they completely closed. Hope you get relief soon.

Becky

Jaimieh · February 2010

bcrooks~ They did a capsulectomy (removed all the scar tissue) and then I had to wear an ace bandage wrapped as tight as possible. I would take it off for about an hour a date after a week and then I slowly increased the time. If I felt I had any fluid I wrapped myself back up. It took a while and it was such a relief when it was over.

cathmg · February 2010

Hello, I had a similar experience with a seroma. Had a bilat mastectomy and had to remove the drains after a few days because they hurt so much. Fluid started building up on my prophylatic side, almost breast shaped under the scar. I had it aspirated weekly for awhile, but the surgeon thought draining it was causing it to constantly produce more fluid. It was a few months later that I met with the PS, who sent me to the hospital to have it flushed out with alcohol in an attempt to dry it up so I could proceed with expanders. I had that procedure done twice, but it didn't seem to have any effect. However, about 3 weeks later it mysteriously went away. I had the expanders put in, and 2 months after that silicone implants, and it hasn't returned. Yes, it can go away, though it was really irritating waiting for that to happen.

Take care,

Catherine

NancyD · February 2010

Jaimieh, how much scar tissue did they have to remove. Had it hardened? When I had my recon last month, the PS said he found a large area of hardened tissue (scar? Necrotic fat? not sure) that he had to carve away at to fit my graft in. There's still some there that I can feel, and wonder if I should ask about having more removed.

Chronic Seroma anyone?

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