Seroma: Causes, Symptoms, Treatment, and Prevention
What Are Seromas and How Do They Form?
When a person undergoes a surgery or experiences a traumatic injury, there will be damage to the smallest of the blood vessels known as the capillaries. When capillaries are damaged, there is leakage of fluid known as the serous fluid that accumulates under the skin. It is this buildup of liquid that can give rise to a seroma. A seroma is different from a hematoma because the latter also contains blood.
What Are the Symptoms of a Seroma?
There are several symptoms that may indicate the possible manifestation of a seroma.
Perhaps one of the common symptoms of a seroma is the appearance of a swelling in or around the area where the surgery took place. However, when the seroma forms deep beneath the skin, the swelling may not be apparent.
2. Fluid leakage
A seroma may cause a continuous discharge through the scar or the wound that was created. If the seroma becomes infected, the leaking fluid may be purulent (containing pus) and foul smelling.
3. Redness and warmth
When the seroma leads becomes inflamed, the surrounding skin may become red and painful. The area may also feel warmer than the other areas of the skin.
4. Fever and chills
Development of a fever with chills usually indicates infection of the seroma..
Sometimes, when the seroma becomes calcified as it heals, it may feel like a hard mass beneath the skin.
Who Is At Risk for Developing a Seroma?
There are a few risk factors that may increase your risk for developing a seroma:
1. Extensive or major surgery
A seroma may form following a major surgery that involves the removal of a large portion of tissue structures. For example, surgical procedures such as the removal of a breast following a breast cancer diagnosis or removal of an internal organ such as a kidney, or even following the removal of excess body fat, as in the case of abdominoplasty surgeries or tummy tucks, gives you a greater risk.
2. Certain procedures
Although not generally considered major surgeries, certain cosmetic procedures could also lead to the formation of a seroma. In this case, the reason for the increased risk is the extensive disruption caused to large amounts of tissues in a particular area, for example, during skin grafting.
3. Past history
When a person has a past history of developing a seroma following a surgery or a traumatic accident, there is a greater likelihood that they will develop a seroma in a subsequent occasion. However, the underlying reason for this phenomenon is unclear.
Can a Seroma Go Away on Its Own?
A small seroma usually settles by itself as the fluid will be slowly absorbed back into the capillaries in the area over the course of a few days to several weeks. However, larger seromas, such as those that occur in breast cancer surgeries, may last for a while and may also recur if the initial healing is not complete.
How Are Seromas Treated and Can They Be Prevented?
When the seroma can be localized clearly, either through palpation or through imaging such as an ultrasound, doctors may also perform fine needle aspiration. Through fine needle aspiration, the fluid can be removed, facilitating better healing of the raw tissue surfaces. Doctors may have to aspirate the serous fluid multiple times until the leakage subsides.
In the event of an infected seroma, you may need intravenous antibiotics because oral antibiotics may not be enough to heal an infected wound. In such instances, you may also need pain relievers and anti-inflammatory agents in order to reduce the swelling and ease the discomfort.
During a surgery, doctors will take every effort to prevent a seroma from forming. These strategies may include: use of blunt surgical instruments to minimize damage to capillaries, avoid the formation of dead spaces which allow fluid collection, and use of various suturing and cauterizing methods to minimize the raw surface area which can leak fluids. Compression garments or pressure bandages over the site of the surgery may prevent dead spaces from forming at the surgical site and thereby minimize the leaking and accumulation of serous fluids. Together, these steps help prevent the formation of a seroma to a large extent.
However, when there is an inherent risk of developing a seroma, doctors may place a drain at the surgical site that would allow serous fluid to flow freely into the outside container rather than accumulate within the body. Once the flow subsides, the drain can be pulled out, and the skin can be sutured.
A seroma usually settles itself although it may take several days and sometimes weeks.
Most of the time, a seroma will not become infected or gives rise to pain. If the it becomes infected, intravenous antibiotics would have to be administered.
Although rare, there are instances where a seroma may recur and would require aspiration or surgical exploration.
Townsend, C. M., & Evers, B. M. (2010). Atlas of General Surgical Techniques E-Book. Elsevier Health Sciences.
Ouldamer, L., Bonastre, J., Brunet-Houdard, S., Body, G., Giraudeau, B., & Caille, A. (2016). Dead space closure with quilting suture versus conventional closure with drainage for the prevention of seroma after mastectomy for breast cancer (QUISERMAS): protocol for a multicentre randomised controlled trial. BMJ open, 6(4), e009903.