Purpose: Evaluate effectiveness of alcohol for ablation of chest wall and axillary postoperative seromas.
Materials and Methods: Retrospective review of consecutive patients who underwent alcohol ablation for postoperative seromas. The ablation procedure involves aspiration of seroma fluid, injection of 100% ethanol for 15-30 minutes, and then aspiration of all ethanol (Figure 1). Following review of the medical record, we recorded the number of aspirations and volume of seroma preceding the ablation. The volume of ethanol and dwell time were recorded. The presence, timing, and volume of any recurrent seromas, repeat aspirations, and complications were recorded. Success was defined as no symptomatic recurrence of seroma.
Results: 20 seromas were ablated in 19 patients (mean age: 63 years, range 49-79 years) following mastectomy (n=9), lumpectomy (n=5), axillary nodal dissection (n=5), or chest wall surgery (n=1). The mean volume of seroma prior to ablation was 146 ± 165 cc. There was a mean of 1.4 prior aspiration attempts (range: 0-3). A mean of 39 cc (range: 8-60 cc) of alcohol was injected for a mean of 26 ± 5 minutes. Seromas recurred in 85% (17/20) cases and a repeat aspiration was performed in 35% (6/17) of seromas. The mean recurrence time was 34 ± 29 days. The recurrent seromas were 31% smaller in size (mean 80 ± 48 cc, Figure 2). Only a smaller pre-ablation seroma was associated with successful ablation, as the mean pre-ablation volume was 36 ± 24 cc for successful ablations and 119 ± 56 cc for unsuccessful ablations (p < 0.01). There were no post-procedural complications.
Conclusion: Single treatment ethanol sclerotherapy is typically unsuccessful in preventing recurrent breast seromas. Only a smaller pre-ablation seroma size was associated with higher success. Multiple sclerosing treatments or alternate sclerosants may be necessary to improve outcomes.
Clinical Relevance Statement: Sclerotherapy for the management of postoperative breast seromas has not been well described in the radiology literature. Single attempt ethanol sclerotherapy is unlikely to be successful; however, approaches that parallel the surgical literature—including alternative sclerosing agents, drain placement, and repeated ablations—warrant further investigation.
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