Is a Seroma the "Kiss of Death"? in Prepectoral Tissue Expander Reconstruction?
Kshipra Hemal*, Sofia Perez Otero, Carter J. Boyd, Raessa Kabir, Vishal Thanik, Jamie P. Levine, Oriana Cohen, Mihye Choi, Nolan S. Karp
Plastic Surgery, NYU Langone Health, New York, NY
Seroma is the most common complication after mastectomy, and it often begets other complications. We investigated the association between seroma and other complications following prepectoral tissue expander (TE) reconstruction.
All consecutive, prepectoral TE reconstructions performed between 03/2017 - 07/2022 at a single center were reviewed. Demographics, mastectomy weight, TE fill, and complications were collected. A p<0.05 was considered statistically significant.
Prepectoral TE reconstruction was performed in 184 patients (292 breasts), who were followed for an average of 27 months. On average, women were 53 years old, non-smoker (99%), non-diabetic (91%), and had a body mass index (BMI) of 28. All breasts underwent immediate reconstruction following prophylactic mastectomies in 33% of cases and therapeutic mastectomies in 67%. The majority of mastectomies were skin sparing (61%), followed by nipple sparing (24%), simple (12%) and other (3%). Seventy-one (24%) breasts were radiated and 89 (48%) patients received chemotherapy. Median mastectomy weight was 551 grams, average intraoperative TE fill was 194 163 mL, and average final TE fill was 416 159 mL.
Seroma occurred in 45 (15%) breasts and was associated with higher BMI (30 vs. 27 kg/m2, p=0.011) and higher mastectomy weight (814 vs. 640 grams, p < 0.05). Seroma breasts had higher rates of postoperative infection (42% vs. 7%, p < 0.001), TE exposure (50% vs. 8%, p <0.05), and explantation (51% vs. 9%, p < 0.001).
A temporal association was also seen: 25 (56%) seromas went on to develop other complications. Infection and explantation commonly followed seroma, occurring in 16 (36%) and 15 (33%) seroma breasts, respectively. Infections were successfully managed with antibiotics in 7 (44%) of breasts, but 9 (56%) required further surgical intervention, such as explantation or exchange.
Although causality cannot be determined, seroma may be the "kiss of death" in prepectoral TE reconstruction, as over half of seroma patients went on to develop other complications.
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