Recurrent late seroma after immediate breast reconstruction with latissimus dorsi musculocutaneous flap

The latissimus dorsi musculocutaneous flap (LDMCF) is widely used for breast reconstruction. However, it has the disadvantage of frequent seroma formation at the donor site, and late seroma has also been reported. The authors report histological findings after the surgical treatment of a late, repeatedly recurrent seroma at 10 years after breast reconstruction with LDMCF. In 2008, a 66-year-old female patient underwent immediate breast reconstruction with LDMCF. In 2015, a late seroma was found at the donor site. After aspiration and drainage, the seroma recurred again in 2018. Total surgical excision of the seroma was performed and bloody-appearing fluid was identified in the capsule. The excised tissue was biopsied. Histological examination revealed no evidence of blood in the fluid, and multinucleated giant cells with amorphous eosinophilic proteinaceous material were identified. The cyst was suggestive of chronic granulomatous inflammation. There was no recurrence at 8 months post-operatively. The patient described herein underwent surgical treatment of late seroma that recurred after immediate breast reconstruction with LDMCF, and histological findings were identified. These results may be helpful for other future studies regarding late seroma after breast reconstruction with LDMCF.

Keywords

Mastectomy - Mammaplasty - Surgical flaps - Superficial back muscles - Seroma

This article was presented as a poster at PRS Korea 2018 on November 9–11, 2018, in Seoul, Korea.

Publication History

Received: 30 March 2019

Accepted: 19 September 2019

Article published online:
22 March 2022

• REFERENCES

• 1 Malata CM, McIntosh SA, Purushotham AD. Immediate breast reconstruction after mastectomy for cancer. Br J Surg 2000; 87: 1455-72
• 2 Menke H, Erkens M, Olbrisch RR. Evolving concepts in breast reconstruction with latissimus dorsi flaps: results and follow-up of 121 consecutive patients. Ann Plast Surg 2001; 47: 107-14
• 3 Schwabegger A, Ninkovic M, Brenner E. et al. Seroma as a common donor site morbidity after harvesting the latissimus dorsi flap: observations on cause and prevention. Ann Plast Surg 1997; 38: 594-7
• 4 Clough KB, Louis-Sylvestre C, Fitoussi A. et al. Donor site sequelae after autologous breast reconstruction with an extended latissimus dorsi flap. Plast Reconstr Surg 2002; 109: 1904-11
• 5 Tomita K, Yano K, Masuoka T. et al. Postoperative seroma formation in breast reconstruction with latissimus dorsi flaps: a retrospective study of 174 consecutive cases. Ann Plast Surg 2007; 59: 149-51
• 6 Randolph LC, Barone J, Angelats J. et al. Prediction of postoperative seroma after latissimus dorsi breast reconstruction. Plast Reconstr Surg 2005; 116: 1287-90
• 7 Say CC, Donegan W. A biostatistical evaluation of complications from mastectomy. Surg Gynecol Obstet 1974; 138: 370-6
• 8 Flew TJ. Wound drainage following radical mastectomy: the effect of restriction of shoulder movement. Br J Surg 1979; 66: 302-5
• 9 Watt-Boolsen S, Nielsen VB, Jensen J. et al. Postmastectomy seroma: a study of the nature and origin of seroma after mastectomy. Dan Med Bull 1989; 36: 487-9
• 10 Bonnema J, Ligtenstein DA, Wiggers T. et al. The composition of serous fluid after axillary dissection. Eur J Surg 1999; 165: 9-13
• 11 Brodbeck WG, Anderson JM. Giant cell formation and function. Curr Opin Hematol 2009; 16: 53-7
• 12 Steinman RM. The dendritic cell system and its role in immunogenicity. Annu Rev Immunol 1991; 9: 271-96
• 13 Matsui Y, Yanagida H, Yoshida H. et al. Seroma with fibrous capsule formation requiring a surgical resection after a modified radical mastectomy: report of a case. Surg Today 1998; 28: 669-72
• 14 Stanczyk M, Grala B, Zwierowicz T. et al. Surgical resection for persistent seroma, following modified radical mastectomy. World J Surg Oncol 2007; 5: 104