Postoperative seroma remains a frequent complication following surgical treatment for breast cancer in both sexes. The reported incidence varies widely, from 3% to 85%, reflecting heterogeneity in definitions, surgical procedures, and reporting. Seroma formation can prolong hospitalization and impair postoperative recovery and patient quality of life.
This narrative review synthesizes current concepts of seroma pathogenesis, maps the multifactorial risk structure, and evaluates contemporary preventive and therapeutic approaches. The authors systematically examined techniques including modern surgical instruments, dead space closure, flap fixation, use of fibrin sealants, and protocols to optimize drainage and its timing.
According to the review, seroma formation is the product of interacting mechanisms rather than a single cause. Two principal processes described are a localized inflammatory response and mechanical lymphatic trauma induced by surgery. The pathogenesis is therefore complex and influenced by the extent of tissue dissection, handling of lymphatic channels, and the inherent healing characteristics of the patient.
Risk factors are multifactorial and include elements related to the surgical strategy (extent of resection, use of flaps), perioperative management (drain placement and protocols), and patient somatic status. The review emphasizes that these interacting variables make a one-size-fits-all preventive approach unlikely to be universally effective.
The wide incidence range (3%–85%) reported highlights variability in procedures, patient populations, and definitions used across studies. Regardless of the exact rate, seromas are clinically significant because they can extend the postoperative course, increase the duration of hospitalization, and diminish patient quality of life. Secondary complications such as infection are a concern when seromas persist or are repeatedly accessed.
A central preventive goal is reduction or elimination of the postoperative dead space where fluid can accumulate. The review examines strategies aimed at closing or minimizing dead space, including meticulous tissue apposition and fixation techniques for surgical flaps. Use of modern surgical instruments and precise hemostasis are presented as components that may reduce seroma risk by limiting inflammatory response and lymphatic leakage.
Evidence across techniques is variable; no single surgical measure is presented as definitively preventive in all settings. The authors advocate combining strategies tailored to the operative plan and patient characteristics.
Topical agents such as fibrin sealants have been evaluated as adjuncts to reduce seroma formation by promoting adherence of tissue planes and sealing lymphatic channels. The review notes that fibrin sealants, flap fixation maneuvers, and similar adjuncts demonstrate varying degrees of efficacy across reports.
Because outcomes differ by patient and procedure, fibrin sealants and flap fixation are described as potentially useful elements within a broader, individualized preventive strategy rather than stand-alone solutions.
Placement of surgical drainage remains a common component of postoperative management. The review considers optimization of drainage protocols, including decisions on when to remove drains, as a modifiable factor in seroma prevention.
Early drain removal is mentioned among preventive measures with variable reported effects. The article highlights that the timing and management of drains should be integrated into the overall prevention plan and adapted to the specific surgical approach and patient healing profile.
Standard therapy for clinically significant postoperative seroma typically involves repeated aspiration puncture to evacuate the collected fluid. Alongside mechanical evacuation, active measures to prevent secondary infection are emphasized as core components of management.
The review does not present a single standardized therapeutic algorithm but indicates that repeated aspiration and vigilance for infection remain the mainstays of current practice.
The authors conclude that there is no universally effective preventive method. Given the complex interplay of surgical technique, tissue healing, and patient somatic status, seroma prevention must be comprehensive and individualized. Combining measures — meticulous surgical technique, dead space closure, considered use of fibrin sealants, optimized drainage protocols, and targeted postoperative care — is recommended.
The review frames seroma prevention as a tailored, multimodal process rather than reliance on any single intervention.
Postoperative seroma after breast cancer surgery remains common and clinically meaningful. Preventive and therapeutic options exist but show heterogeneous efficacy. The review calls for individualized, comprehensive strategies that consider surgical approach and patient factors. Specific comparative outcome data, standardized protocols, and detailed efficacy measures were not reported in the abstract of the source, indicating areas where further evidence synthesis or primary research may be needed.