Lymphatic contribution in a chronic breast seroma: a case report

A seroma is a common complication of any surgical procedure that creates dead space allowing for fluid collection. The etiology of seroma formation is not uniform and has been attributed to fibrosis, a subclinical infection, aberrant behavior of lining cells, or lymphatic leak. Contribution of lymphatic flow as the main cause of a persistent seroma seems particularly relevant if the surgery involved damage to adjacent lymphatic structures. We describe a case of a 61-year-old female who presented with a chronic breast seroma despite 13 months of intermittent drainage and attempts at sclerotherapy. Previously, the patient underwent right breast reconstruction with a tissue expander and latissimus dorsi flap following a modified radical mastectomy and failed right sided reconstruction with a deep inferior epigastric perforator flap for breast cancer. To address the chronic seroma, reverse axillary lymphatic mapping was performed prior to seroma excision to visualize a suspected lymphatic contribution. A single lymphatic collector connecting to the seroma cavity was visualized. After ligation of the lymphatic vessel and replacement of the latissimus dorsi and tissue expander, the seroma was finally cured. With this report, we would like to emphasize that identification and elimination of contributing lymphatic vessels appears to be the key component in management of persistent seromas in the basin of major lymphatic drainage.