Does a seroma always have to be drained?
I think I have some sort of fluid collection under one of my new DIEP flaps. I'm 3 weeks post-op. The drains for the flaps were removed at my first follow-up appointment, about 1.5 weeks post-op, since they weren't putting out much at all. I don't actually know if the fluid has been there this whole time or if it's new. I think overall, my swelling is actually down a bit. No new pain either. But I have had more chest wall pain on that side for a couple of weeks, which has actually been improving lately. My next follow-up is tomorrow... I just want to have some idea of what to expect.
Comments
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I had one in my right breast post surgery. They didn't drain it and it eventually absorbed. I will say, It took a long time- almost a full year.
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Well they did drain it. 70 cc of fluid. I felt the lidocaine, but didn't really feel anything else. It was just a little strange watching it! I do notice less pain on that side now though. They said a collection of fluid is a risk for infection, plus it delays healing. But the fact that it was in the area of the newly connected blood vessels in my DIEP flap seemed to be the deciding factor.
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ducky - good news and glad you're feeling better
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They do not have to be drained. Some docs won't do it unless it's causing discomfort because they can fill again and draining brings risk of infection. I had mine well over a year before it absorbed on its own.
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My axillary (SNB) seroma ruptured and essentially drained itself-- fortunately, after that incision was sutured (it was originally just glued and Steri-stripped) it healed uneventfully and is gone. As to the mammary seroma, we’re dealing with it via massage, a Solaris Swell Spot pad and triamcinolone ointment (the latter prescribed by my derm). The BS, MO, RO and LE doc all said it could take a year or more to resorb and there are far greater risks to draining it (and it’s still soon enough post-op that it’d likely just refill).
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I'm 8 weeks out from having my saline implants replaced from the last ones I got 13 years ago...My right side (also the side I had BC on is getting bigger than the left...I called MD Anderson, talked w/a PA, and she said to watch it and I was scheduled to come in in May...Last night it was very painful, and I used a heating pad which really helped and I was able to go to sleep...I don't see anything on that side, it's just painful at the end of the day...Some questions: Is there anything I can do, proactively, to keep this thing (if in fact it is a seroma) from getting bigger? Should I wear a sports bra (tighter than regular bar), should I do massage...Is it safe to use a heating pad...Does working in the yard aggravate the situation? I'm so annoyed they gave me nothing but "let's watch it"...I need some answers and some help! I will call them again tomorrow, but hoped I could get some support here...Thanks ladies, Maggie a/k/a maggerle on the board...
Also, wanted to add that if I was supposed to start a new thread, for my issue, I do apologize...This is my first time here, and not familiar w/protocol...Thanks for your patience! maggie
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I don't know that much about it unfortunately, but I would be hesitant to use the heating pad.
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Dear Maggerle, You are welcome to post here or start a new topic as you wish. let us know via PM if you need help getting started with the boards. We welcome you here and hope you get some thoughts from others. It makes sense to recontact your doctor's practice if you are having increased symptoms. Here is some information on Seromas on our website if you want to read more. The Mods
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Thank You!
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Maggerle, the surgeon can only determine whether this is a seroma (or one of multiple other possibilities), and whether it needs to be treated, by examining you. If you are still uncomfortable, please call the surgeon and ask to be seen asap. If you traveled for surgery, an alternative would be to visit the ER in a local hospital.
And yes, in some cases, gardening could exacerbate the leakage of blood or lymph fluid, so I'd stay a bit quiet until a surgeon has examined you.
My seroma appeared on a Sunday, so I went to the ER. They scheduled a visit to the BS on Monday, and I had surgery on Tuesday. I use the term, "surgery" because rather than inserting a syringe and removing fluid, they took me to the OR, reopened my sentinel node incision, found the bleeder, and fixed it. It was a very minor procedure, as was the recovery.
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This may be a repost as I am not sure if the other one posted. My surgeon had to put in a drain about a month after surgery for a seroma. I have had the tube in for 5 weeks and I am wondering if this has happened to anyone else. If so how long did you have to have the drain in? It is keeping me from having the radiation.
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Dear Frustratedwithdrain, Welcome to the community. We are sorry about your situation but glad that you reached out here. We hope you will receive some others who may have dealt with seromas. Please stay connected and keep us posted. The MOds
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Frustratedwithdrain, I had a similar experience. I had a huge hematoma after my lumpectomy. I mean huge, like over 500cc. They had to take me back for re-excision, during which they cleaned out all the old blood. After the re-excision, I developed a huge seroma in that area. OMG. What a mess that was. I noticed it on the Sunday before Labor Day, so couldn't get in to see the BS until Tues. Well, it opened up Monday night and was leaking everywhere. Tuesday she needled it and got out about 100cc. I was scheduled to come back in on Fri to check it. It opened up Thurs night and was gushing like a fountain. Gack! Had two more visits after that, during which she kept getting over 90cc every time. The BS put a drain in. Then the whole thing got massively infected! She pulled the drain out and the seroma filled up AGAIN! She put in ANOTHER drain. My God. This went on over the course of 6 weeks and held up chemo. I thought this thing would never heal, but it finally did. I just had BMX Feb 4 and I fully expected it to fill up again, but it didn't. Yay!
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That sounds much worse, sorry you had to go through that. Did the Dr. suggest anything to help stop it. Mine is about 40-60 ccs. Praying it doesn't decided to pay another visit.
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The drain is what finally stopped it. It got to where it was only putting out about 15-20cc a day when she pulled it. Thankfully, it stopped there and just reabsorbed. To my knowledge, it has disappeared now.
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Hi All,
Maybe some clarifications on seroma for those new to breast surgery.
Anyone can get one, they take time to reabsorb,etc.
Some of the descriptions are rather extraordinary and seem like way more than your average seroma.....seems like bad surgery, microbleeds, reconstruction mishaps,etc.
Guess there are simple seromas ( those easily drained, or eventually reabsorbed) .
Complex seromas...those with large volumes of lymph fluid, microbleeds, reconstruction issues, etc.
It would be useful to know whether most seromas are simple or more problematic for the premenopausal crowds, botched surgeries, reconstruction, vs. no reconstruction.
When you get one they are kinda creepy, feel like a small silicone implant in the wrong place.
For example: I am very post menopausal at 60 plus and I had a very large breast cancer on a large breast and neovalent chemo in right breast and breast and nodes removed. Hardly any bleeding, and no seroma issues. Had radiation after that. Fast forward a year later. Same hospital, same surgeon. Had prophylactic mastectomy, no nodes, extensive bruising ( fingermark bruises ) on chest had a good sized seroma easily drained in breast surgeon office but to this day have slight microbleed discoloration from trauma or perhaps better blood supply or perhaps surgeon used contracted operating help and not as good a job. No reconstruction. (Skin Mets on chest plus local chest wall and subclavian nodes a half a year later after rads and chemo. Seroma side ok. ) . Now NED on Perjeta/Herceptin after doxitacel.
Newbie20111
( newbienomore)
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You are probably right about the explanation. I unfortunately had cancer in both breasts and ended up just having to have lumpectomy on both sides. I did develop a seroma on the other side however, it was very small and reabsorbed right away. The surgeon said that it is not common to get one. In fact I posted on a group on facebook that I belong to and only one person responded that they had one.
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I have heard from many people that they develop seromas. Basically your body tries to fill in newly "open" areas with fluid. It is not necessarily a bad thing. Mine was in the area of my lymph node dissection. I had a drain in place for about 2 weeks after surgery and then had to have it aspirated by needle 3x. Compression helped (but was difficult as it was on my side under my armpit). And, also exercise actually helped too. It was not painful at all and felt like "golf ball" under my arm. It has now reabsorbed.
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Hi frustrated, I had a terrible seroma with my SNL. It is probably because the surgeon took 14 lymph nodes instead of just the one. It was so big under my arm that I could not put my arm all the was down. They drained it when I had the mastectomy but it scared me really badly because they did not warn me about it. They said, "oh sorry, we should have put a drain in". Hope you are feeling better.
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knitting PT That is where mine is also, under my arm, where the sentinel node biopsy was done. What kind of exercises did you do ? The surgeon said to use it as little as possible. Thanks for your response
Fe Princess It is very scary. My surgeon did warn me he did not put a drain in right away either. Not sure if it would have helped or not. I wouldn't care except it is delaying the radiation. Thank you for answering .
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The clinical explanation is that “Nature abhors a vacuum." (Note: so do my cats). But I think that everyone's body is different, and there may be predisposing factors that affect the size and duration of seromas. I remembered that I also had a "small seroma" (as my radiologist described at the time she implanted my pre-op radioactive seed) at the core biopsy site, which explains why I'd panicked in the two weeks between biopsy and lumpectomy over a pea-sized lump that I'd feared was a new tumor.
But in retrospect, I realize that the main reason may be that I have a hair-trigger immune system: not only do I get seasonal allergic rhinitis at the drop of a tree blossom (or weed pollen grain or mold spore), but I have very sensitive skin and form blisters at the slightest provocation. (Shoe salesmen duck behind the counter in terror when I walk in, because I reject shoe after shoe that has any sharp edge, seam or protruding stitch, insisting that it'd inevitably cause a blister). I can wear the most cushioned running or walking shoe and thick wicking socks, but unless I pre-bandage my trouble spots securely I will still get a painful blister that has to be babied lest it pop and get infected--and sometimes it'll pop anyway.
And what is a blister, after all, but a small seroma that develops between the dermis and epidermis? The difference is merely one of scale. Just as your body responds to the irritation of your skin by cloaking it in fluid to soothe and protect it from further injury, so too does it respond to the injuries it has perceived to your axillary lymph node area and breast tissue surrounding the area from which your tumor and margin tissue have been removed.
So I don't want to be Debbie Downer, but if you habitually get blisters, you will probably get a seroma or two--and draining them will not prevent their refilling. Your body wants to do what it wants to do, and all you can do in response is to manage your seromas to keep them from getting worse and help them to resorb on their own. You have to adapt, and above all be patient.
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ChiSandy that is a perfect explaination. You are so right about a body doing what it wants to do. I don't get blisters but my body often has strange reactions to things. Thank you for answering
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I have done stretching and strengthening exercises. But my surgeon didn't want me to start until she cleared me. Now, I do my normal exercise routine (yoga, strength training, etc).
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Frustrated, can they put a drain in it when you are getting radiation?
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Fe Princess I am not sure although I don't think so. The radiologist onc is aware I have the drain and is saying to wait until it is out.
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The waiting game sucks. I am so sorry. I will have a SGAP in 5 weeks and will have drains again. I hope it goes quickly for me. What is your timeline? What is your diagnosis?
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I am very excited to say that the drain is out!!!! Calling the radiologist tomorrow to see about the radiation.
Fe Princess I don't think I ever answered your question. I don't know the stage, I didn't want to know, afraid if it was to far I wouldn't fight as hard. I do know ER/Pr+ and HER2+. I had it in both breasts. The other side was ER+ PR- and HER2+. I was very blessed in that I had 6 tcph and had total response in left side. The other semi complication was the DR. didn't get clear margins on the right and had to go back. He did get clear margins the second time. I'm on herceptin now along with armidex(sp) and hopefully I'll get the radiation going in the next week or so.
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hello- i have a large seroma under r axilla drained x 4. pressing on incision. is the rule of thumb to drain or not to drain? exercise or not? compress or not? so frustrating losing time at work and social events
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stacydotts, you may find some helpful information on this page: Seroma
We are sorry to hear about what you are experiencing!
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We often forget that breasts are very dynamic throughout our lives and many factors contribute to their changes: breast cancer treatment, infections,anatomy, hormones,trauma, aging,etc. Guess the bottom line is know thy breasts (chest), chest wall and axillas ( armpits) .If it seems abnormal or different maybe it is. Get it checked out, get a second opionion, and if you have cancer treatment expect some pretty radical changes.
Be kind to yourself and work with your body. After initial healing seek complementary treatments such as lymphedema therapy,acupuncture, safe exercise and get off the couch, walk the dog, take the stairs, and go live your life. Heart,brain,soul
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