Seromas

sickgirl

Hi there, I had surgery in may last year bilateral mastectomy and auxiliary clearance. I have a couple of seromas on side lump was found. Surgeon said he could syringe but wouldnt as too risky of infection and it was during chemo. Wondered if necessary to have it syringed and why? Did surgeon do yours?
Thanks

Afraser

Yes I did. I had a long lasting, very large seroma. Conventional wisdom is not to aspirate (remove the fluid by needle) for the reason your surgeon indicates. Removal of fluid may lead to the area simply filling again. But the fluid can cause problems, not least of all a nice, nutritious home for bacterial growth in your body. I had mine while having chemo and my oncologist wasn't so happy about the fluid remaining, on the grounds of possible infection. If the seromas are not causing you any difficulty, and you have not experienced any signs of infection (possibly flu like symptoms or generally feeling unwell) then it may still be best to wait and see if they disperse. It is also possible that a trained lymphoedemic therapist may help this by massage. I ended up with several aspirations (there was so much fluid I sloshed when I bent over!). Whether that caused the infection or, as my surgeon felt, the infection was caused by the persistent build up of fluid supporting bacteria, is an interesting question. The ultimate infection landed me in hospital for a week, surgery to clear the infection source and that in turn finally cleared up the seroma. Best of luck. 

sickgirl

Hi Afraser, thanks for the response. Yes I definitely wasn’t going to have it touched while having chemo but now as approaching 2nd follow up with surgeon I’m wondering if he will just want to go ahead and drain it as will have been 11mths and still there. I have still been feeling unwell but who would know why that is. Left over from chemo? Still on herceptin till September? Have just started on letrozole (femara) (aromatase inhibitor) (hormone therapy)? This is why I wonder whether I should have seromas drained and is it painful? Can you use emlar patches? The lymphodemic therapists are they generally in the public hospitals do you know? Wondering if could be referred to one. I do have lymphodema and wear a compression sleeve and glove and see a physio at public hospital but she just measures my arm every couple weeks and that’s about it?

Afraser

Hmm. My terrific lymphoedema therapist notes that officially there isn't a connection between a seroma and lymphoedema but as she puts it, it's hard to let the water out when the plug is still in the sink! I get my arm massaged every 4/5 weeks to keep my fluid levels down and my lymphatic system moving. It does cost a bit, but partly covered by my health insurance. Aspirations were never painful but rarely had any long lasting benefit - I "refilled" in days. So I am not sure what caused what. As you say, if you have general unwell symptoms it's hard to know when you have had multiple treatments. I never had any problem with herceptin, and while I do have some letrozole side effects, they are very specific. My oncologist had no qualms about draining, he didn't like the idea of chemo affected fluid hanging around. Different medicos, different approaches. I would certainly think it's worth seeing if your hospital has a lymphoedema therapist, rather than a general physio, or if you can be referred to one and what it may cost. Bottom line is how much trouble the seroma is causing? My first aspiration removed 1.5 litres - I was staggered but it explained why my mastectomy had left me quite rounded!! 

Mira

Hi, I had a seroma after my operation and ended up in the ER late one night.  Luckily one of the breast surgeons registrars was working that night and she said not to drain it due to the risk of infection.  It was a bit funny, I was sitting there half naked and she was explaining to the nurse/doctor who was there all about seromas and why they don't drain them, and how they are made up , until I kinda coughed after about 5 - 10 mins and said "Can I put my clothes back on yet?"  According to her, they are like sponges so draining them isn't the same as just popping a needle into a balloon and sucking out the fluid.  It was an interesting lesson.

sickgirl

Hi Mira, so why did you end up in the ER? I understand not draining them during chemo for risk of infection but were they saying never to drain them ever? 

Afraser

I can understand about the sponge thing - mine formed in one main cavity but spread to several small ones, so not really possible to drain it all. But the risk can go both ways - perfectly healthy people have some potentially nasty bacteria in their bodies and it can sometimes develop in an environment which provides excellent nutrition for bugs! Best possible outcome is for natural dispersal, which is why I think massage should be encouraged more. 

Mira

Hey sickgirl, I ended up in ER because I am a wuss.  It was really painful and only a few days after my op and I was worried about it.  I thought it was huge, but the registrar looked at it and said "it's not like it's as big as a football" so I'm guessing they get a lot bigger.  They gave me some strong pain medication and sent me home, I was fine in a couple of days.   It went down on its own. 

sickgirl

Oh no your not. This is a scary horrible time for us all and I’d probably have gone there too. What a silly thing to say it’s not as big as a football doesn’t mean it’s not painful and worrying when you know nothing about them! How long is it since you had your surgery?

Mira

Oh no, she was lovely!  I wasn't offended at all, in fact when I said to her "so are you saying I am a wuss?" she blushed bright red and started stammering.  I had the best surgical team, they were all lovely.   It's been about 3 years since I had my cancer removed.  I was lucky, they caught it early enough for a lumpectomy and radiation to be the treatment and I haven't had many problems other than the seroma and a stitch that didn't dissolve and had to be pulled out. 

sickgirl

That’s ok then lol. That’s good you’ve come out of it all ok then. I had bilateral mastectomy last may had 6 mths chemo then 5 weeks radiation. As was triple positive having herceptin till sept and now on home therapy for at least 5 yrs. Still don’t feel so great. My seroma is still there since surgery just seeing whether I should leave or do something about.

sickgirl

That should have said hormone therapy