SAN ANTONIO – Women who form a seroma following breast cancer surgery are at threefold increased risk of developing lymphedema, a case-control study has shown.
Of 135 breast cancer survivors (26%) participating in the study, 35 developed postsurgical symptomatic seromas requiring needle aspiration. The seromas were located in the axilla, upper chest, and breast.
Of the 35 women with a seroma, 33 had a greater than 200-mL increase in arm volume. Based on the International Criteria for Lymphedema Diagnosis, 26 of the 35 women with a seroma had severe lymphedema, 6 had moderate lymphedema, and 3 had mild lymphedema symptoms, Mei R. Fu, Ph.D., reported at the annual San Antonio Breast Cancer Symposium.
Patients with a higher body mass index were significantly more likely to form a seroma; however, age, type of surgery performed, axillary lymph node status, and number of nodes removed proved unrelated to the occurrence of a seroma, according to Dr. Fu of the New York University College of Nursing.
Lymphedema is caused by accumulation of lymphatic fluid in interstitial spaces due to injury to the lymphatic system as a consequence of breast cancer therapy. Patients dread this common, distressing, long-term, and indeed often lifelong complication, she said.
Lymphedema is a syndrome with multiple symptoms. In this study, seroma formation – that is, excessive build-up of serous fluid – was associated with a markedly increased likelihood of the lymphedema-related symptoms of arm swelling, heaviness, numbness, stiffness, firmness, tenderness, and redness, as well as increased arm temperature. Patients with a seroma had a greater number of lymphedema-related symptoms than did women who developed lymphedema without a seroma.
A seroma is believed to form in response to surgical trauma and leakage of inflammatory exudates in the acute phase of wound healing. The excessive build-up of serous fluid leads to delayed wound healing, with tissue inflammation followed by fibrosis and necrosis.
Current standard management of a symptomatic seroma consists of needle aspiration, which may need to be done repeatedly. The clinical implication of this study is that aspiration of serous fluid isn’t sufficient to prevent lymphedema, Dr. Fu said. Further research is warranted on a novel means of preventing symptomatic seroma formation as a means of avoiding the development of lymphedema. Possibilities include the use of ultrasound for early detection and drainage of subclinical seromas, as well as potent anti-inflammatory therapy.
Her study was funded by the Avon Foundation and grants from other nonprofit organizations. She said she had no relevant financial disclosures.