Seroma

[Afroza]

I had my BCS [lumpectomy to remove a tumor (2X1.5X1 cms) from my right breast and removal of 19 lymph nodes ( probably all of Level I & II ) from right axilla] was done on 22nd March, 2002. Post surgery microscopic examination revealed the tumor of IDC Grade-II but the lymph nodes were uninvolved. The Surgeon put a drain at the axilla and which was removed on 4th April, 2002, while the 24 hours collection of Seroma was about 100 ml. Later I took Chemo of CEF Regimen on 5th April, 2002 (1st cycle) & 26th April, 2002 (2nd cycle). My Seroma aspirations post removal of drainage was once in a week  @ 140 ml from axilla and @15 ml from the breast.From 5th April, 2002 I got fever , severe infection and reddish inflamation at the upper part of the breast above the surgical scar and the axilla below the surgical scar. The fever was managed well with antibiotics by two-days but the rate of improvement of the pain, tenderness and reddish inflamation at those places are very slow and did not subside totally. Microscopic examination of the aspirated fluid from axilla revealed no malignancy but degenerated cells of many lymphocytes and gram positive cocci. My blood counts on 14th May, 2002 was, T/C: WBC-9,000 per c.mm, D/C: Polymorphs-70% and Lymphocytes-24%%.Under coverage of antibiotics I took my 3rd cycle of chemotherapy on 17th May, 2002.

Question 1:-
Was it all right to remove 19 uninvolved Lymph nodes; and the drain from axilla on 5th April, 2002 while the last 24 hrs. seroma collection was about 100 ml ?  

Question 2:-
Was it all right to take chemo on 17th May, 2002 ?

[Mr. Seroma]

Dear Sirs/ Madames, --My huge problem concerns seromas and while not directly related to breast cancer per se, it is indirectly related, and i am at the end of my rope in getting effective help and advice, and do not know where to turn. --On 2/28/02 I had a abdominalplasty to remove some excess skin that would not go away with exercise. I developed a seroma in the second week, and had weekly or bi-weekly aspirations(drainages)throughout March and April. Initial drainages were over 250cc, and gradually they reduced to as low as 15CC, but would never go away completely. The seroma was centered on the left side of my lower abdominal region below the belly button, but extended across below the belly button to the right side.I wore a belt 24 hrs a day, but in this time the belt was not the best suited for this. On 4/30/02, i had a operation to reinsert a drain. This was kept in for 10 days, and reduced drainage from 55CC/ day to about 25CC/ day. I bought 2 new belts and wore them constantly. I refrained from all physical activities (which was espicially hard for me--as I am used to exercising 3 -5 times a week, and have been doing this for over 15 years consistently). Throughout May and June, weekly, or bi weekly drainages were made--But, THE ACCUMULATION OF SERUM NEVER STOPPED.
In early July, we tried 2 and 3 drainages per week, but the serum kept coming (sometimes as low as 5CC/ day rate--but, if left undrained, my body would not absord the fluid, but rather would increase to 30--40CC, etc. In mid -July, we tried injecting tetracycline,as a irritant into the seroma, but this just INCREASED the amount of serum produced. On 8/2/02, i had another operation to remove the scar tisshue producing the serum. My doctor said it was very, very thick in places. I have had a drain in and daily drainages have been 200CC, 110, 100, 40, 21, 21, 16, 9, 10, 17, and 5. However, on the 8th day after sugery, ANOTHER SEROMA DEVELOPED in a new spot--the upper abdomin, above the belly button--where scar tisshue was removed. There is a bubble of serum that can be moved within a certain area. This fluid CANNOT DRAIN into the drain because it appears that the lower ab has healed (no fluid there), and the drain is positioned there--below the belly button.I have positioned my new belt to force this fluid down to where the drain is--but this has not worked for the last 4 days, and despite keeping a tight pressure there, it is increasing in fluid and area,if anything. So, after,5 1/2 months, I still have a uncomfortable fluid buildup, I am been wearing uncomfortable tight belts 23 and 1/2 hrs a day, restricting activities, and exercise, I am normally very athletic, low % bodyfat,etc.-but have had no swimming,dancing, bicycling, weeding, housework, cleaning, painting, dog walking, etc. for almost 6 months and am at the end of my rope, as my life, as i want to lead it has been totally shattered by this. My questions are why can't my body absorb the fluid, and what can we do to help this new seroma heal before new scar tisshue developes. The current drain has outlived its usefulness, but can it be repositioned to the new area without another operation? How long can a drain stay in without negative consequences?(I am concerned about a permanent scar).Are there any new approaches available that we haven't tried? Does anyone, anywhere have experience with a seroma refusing to heal this long? Can i help myself heal in any other way by vitamins, drugs, food, etc? Am I condemned to having a permanent seroma because of my vanity?

[Fresen]

A related discussion, Seroma after mastectomy with lymph node dissection was started.

[CCF-RN,MSN-rf]

Dear afroza:  It is standard procedure to remove all of the lymph nodes contained in the fat pad in the axilla.  The actual number of lymph nodes varies widely.  The timing of drain removal depends on the amount of drainage as well as doctor preference.  There is no "magic" amount of drainage that defines removal.  Clearly, from your experience, you had not healed well enough initially to begin chemotherapy.  If all is resolved now, it would be okay to proceed with chemotherapy.  Your white blood cells appear to be in the normal range which is usually the limiting factor in deciding whether or not to proceed with chemotherapy, assuming all outward appearance of infection has resolved.  Even in the best situations, infections can occur.