New risk factors for donor site seroma formation after latissimus dorsi flap breast reconstruction: 10-year period outcome analysis

Introduction: Latissimus dorsi flap breast reconstruction is associated with a high incidence of donor site seromas. After using several preventive operative techniques, we were able to reduce postoperative complications in a standard operation procedure. The aim of this study was to evaluate the effect of various risk factors related to incidence, volume and frequency of seroma aspiration. Methods: A retrospective review of 87 latissimus dorsi breast reconstructions over a 10-year period was carried out. Associations between potential risk factors and outcome (total drainage volume, number of aspirations and total seroma volume) were investigated on a descriptive level by means of correlation analysis and on an analytical level by multiple linear regression analysis. Results: Correlation analysis showed that co-morbidity and higher body mass index (BMI, in kilograms per square metre) were associated with larger seroma volumes. BMI remained a significant risk factor also after adjustment for other co-variates (p < 0.001, linear regression). Moreover, patients receiving selective serotonin reuptake inhibitors (SSRIs) presented significantly higher seroma volumes (p = 0.047, linear regression). At a trend level (p < 0.1), post-operative hypertension, lower Ca +/- - levels and a reduction in haemoglobin levels (before vs. after operation) were also associated with larger seroma volumes. Discussion: This study, besides observing the effects of well-established risk factors such as age, BMI and surgical operation techniques, identified new risk factors, in particular the perioperative use of SSRIs and the calcium balance, which should be considered in patients in pre-and postoperative care. (C) 2010 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.