Seromas and Punctures after Complete Axillary Node Dissection for Breast Cancer: Differences between Mastectomy and Lumpectomy

Background: “Seromas” represent a frequent complication after complete axillary lymph node dissection (CALND) for breast cancer. The aims of this work were to analyze patients with seromas at our institution and to try to define patients at risk for such events. Methods: The medical reports of 223 women who underwent CALND after mastectomy (n=127) or lumpectomy (n=96) for breast cancer and who were followed in our institute were retrospectively reviewed to obtain the following: the characteristics (volume and duration) of the drained seromas; the number, volume, and duration of punctures performed after hospital discharge; the patient's age and body mass index; the presence or absence of hypertension (HTA); the pT of the tumor, the TNM stage, the number of axillary lymph nodes removed (nLN), the number of positive LN, the associated treatments (the pre and post-operative chemotherapy or not); and whether or not there was an infection at the level of the breast and/or arm. Results: Only 18.75% of the patients after lumpectomy and 9.45% after mastectomy did not have a puncture for seroma after hospital discharge. The patients who had a mastectomy with CALND had a significantly higher number of punctures (Np), longer duration, and higher volumes than those who had a lumpectomy. The risk of infection significantly increased with the Np. Conclusions: This institutional survey highlights the problem of post-operative seromas and their related punctures. The seromas were statistically more frequent after mastectomy than lumpectomy. Therefore, in the future, neo-adjuvant approaches with conservative surgeries are recommended. Our analysis identified an abnormally high Np and/or total puncture volume (VpTot) as outliers.