ICID > Clinical Management > General Surgery > Seroma Drainage  

Seroma Drainage 

  • 1. Indications
  • 2. Clinical Management
  • 3. Patient Information
  • 4. Audit
  • 5. Evidence Base
  • 6. Appendices
  • 1. Indications

    1.1 Background

    Formation of a seroma most frequently occurs after mastectomy and axillary surgery. Prolonged drainage is troublesome as it increases the risk for infection and can significantly delay adjuvant therapy. Seroma has been defined as serous fluid collection under the skin flaps or in the axillary dead space following mastectomy and/or axillary dissection. No patient or tumour factors seem to affect seroma formation except body mass index and body weight. Consensus is lacking among studies/trials with different groups producing conflicting evidence. Besides a few established factors such as body mass index, the use of electrocautery for dissection, early drain removal, low vacuum drains, obliteration of dead space, and delayed shoulder physiotherapy, most of the hypothesized causes have not been demonstrated consistently. Thus, seroma remains a threat to both the patient and surgeon. Recurrent transcutaneous aspiration remains the only successful management. [1]

    1.2 Aim/purpose

    For the Breast Care Team to

    1. Assess the need to drain the seroma.

    2. Safely drain the seroma.

    1.3 Patient/client group

    Patients who have undergone axillary surgery as part of breast cancer surgery.

    1.4 Exceptions/ contraindications

    The Breast Care Team should avoid aspiration if collection of fluid is < 50 mls, if the patient is taking anti-coagulants or if there is evidence of infection or inflammation.

    1.5 Options


    2. Clinical Management

    2.1 Staff & equipment

    Seroma assessment and drainage is considered to be an expanded nursing practice within this Trust.

    The Breast Care Team following training and competency based expanded practice assessment are then allowed to 'perform' this procedure.

    The process for undertaking advanced practice is:-

    1. Supervised practice.

    2. Practice assessment.

    3. Observed practice.

    In line with NMC The Code 2015 (2) guidelines keep clear and accurate records relevant to your practice. There must be a current and appropriate plan of care for patients requiring seroma drainage. [2]

    2.2 Method/procedure

    Equipment required:


    50 ml luerlock syringe        Disposable gloves

    Disinfection wipe              Disposable apron

    21G needle                    Inco sheet

    3 way tap


    Dressing Tape




    Assess patient

    Ascertain "degree" of seroma and if this indicates drainage.

    Position patient comfortably usually in an upright sitting position on couch


    Explain procedure to patient and obtain verbal consent.


    Prepare equipment.


    Wash hands

    Minimise risk of infection.

    Prepare dressing trolley with additional gauze.

    Ensure cleanliness is maintained.  Be prepared for leakage of seroma fluid.

    Put on disposable gloves

    Be aware of contamination by seroma fluid.

    Prepare 50 ml syringe and 21G needle and 3 way tap.

    Large bore needle facilitates aspiration.  Large syringe reduces disconnection required.

    Cleanse patients skin using disinfection wipe and allow to dry.

    Achieve full cleanliness.

    Insert needle into lower aspect of the seroma – at an angle of < 50 degrees.

    Gravity assists aspiration.  Ensuring chest wall is not punctured.

    Aspirate seroma noting amount and type of fluid.

    Accurately record for progress and audit purposes.

    If seroma does not immediately aspirate – gently move needle within fluid.

    Seromas can be loculated.

    If aspiration is unsuccessful another puncture site can be used, maximum 3 attempts.


    Use new needle for each further attempt.

    Maintain cleanliness.

    When aspiration complete cleanse skin of any seroma fluid leakage.

    Maintain cleanliness.

    Apply dry dressing – gauze and fix firmly.  Arrange dressing to achieve some pressure.

    Pressure for 24 hours may assist skin flaps to adhere to chest wall and reduce further collection of lymphocele.

    Ensure patient feels comfortable.


    Inform patient when to remove dressing and when to resume arm exercises and ascertain next appointment.

    Keep patient informed to reduce anxiety.

    Document on Somerset Cancer database.

    Maintain accurate records.

    If patients have any concerns at all they should contact the Breast Specialist Nurse.

    2.3 Potential complications / Risk Management


    The Breast Care Team may be able to detect infection within the seroma fluid. It is essential to observe the colour of the fluid drained. If the specimen is cloudy, send a specimen for culture and sensitivity and record in Somerset Cancer database. The patient or their general practitioner will need to be notified if antibiotics are appropriate or not.

    If the patient experiences any difficulty in breathing after seroma drainage they should contact either the Breast Care Team, GP and A & E department. They may require a CXR and medical treatment.

    2.4 After care

    1. The patient can remove the dressing later that day.

    2. The Breast Care Team will make the patient a further appointment for aspiration of seroma if required.

    3. The amount and type of fluid will be recorded on the Somerset Cancer database.

    3. Patient Information

    Seroma drainage is discussed in the patient information booklet given pre-operatively, this includes contact numbers.

    4. Audit

    4.1 Audit Indicators

    Standard Statement –

    All patients who experience a seroma post breast surgery with axillary intervention should receive care according to the Trust Protocol.


    1. Patients should have the opportunity to discuss the treatment and aims of seroma drainage with the breast specialist nurse.

    2. Patients should receive verbal and written information about seromas and their treatment.

    3. Patients should receive care according to seroma protocol.

    4. Seroma drainage should be performed by a competent member of the Breast Care Team.

    5. Reiterate contact numbers for Breast Care Team.


    1. The patient will be welcomed to the breast care department clinical room.

    2. Anxieties of the patient should be addressed.

    3. The procedure should be explained to the patient.

    4. An explanation of what the patient might experience should be given.

    5. The procedure should be carried out according to seroma protocol.

    6. Throughout the drainage procedure the patients comfort and anxieties should be addressed.


    1. The patient has received the care according to the seroma protocol.

    2. The seroma has been assessed and drained (if necessary) by a competent member of the Breast Care Team.

    3. The patient's physical and psychological needs were met.

    4. The patient has received information pertaining to their aftercare.

    5. The drainage of the seroma was carried out using a clean technique.

    6. All care documented on the Somerset Cancer database.

    4.2 Audit design

    1. The patient has received the written and verbal information according to their needs and to ensure safe administration.

    2. The patient has received the care according to the protocol, Trust guidelines and their own needs.

    3. The seroma has been assessed and drained by a competent member of the Breast Team.

    4. The patient was well informed throughout the process.

    5. The patient was given opportunities to express anxieties and needs during their stay.

    6. The patient was given aftercare information and contact numbers.

    4.3 User Involvement

    Patient verbal feedback documented as appropriate on the Somerset Cancer database.

    4.4 Risk Management

    Factors Associated with Seroma Drainage


    Risk Management

    Administration Factors

    Nursing staff inexperienced in the drainage of seromas.

    As part Clinical Nurse Specialist Advanced Practice Training they will receive sufficient training in seroma drainage in patients who have undergone axillary surgery.

    Consent not obtained

    Nursing staff to check that informed verbal consent has been obtained.

    Information on incidence of seroma not given.

    Refer to patient Information leaflet

    Environment conducive to the drainage of seromas.

    Appropriate privacy available for the drainage of seromas.

    Treatment Delivery Factors

    Accidental needle damage to pleura.

    Patient to inform GP / A&E of any breathing difficulties.

    Risk of infection.

    Assessing wound for signs of inflammation, medical referral if appropriate.

    Inappropriate preparation of clean field.

    Clean technique to be used in the drainage of seromas.

    Physiologic Factors

    During seroma treatment

    Limitations on exercising and arm mobility.

    Patient Characteristics

    Patient extremely anxious or depressed.

    Signpost to appropriate area of care i.e. Wellbeing/Psychological Support Programme

    5. Evidence Base

    5.1 Sources of information

    1. Srivastava V1, Basu S, Shukla VK.( 2012) Seroma formation after breast cancer surgery: what we have learned in the last two decades. Journal Breast Cancer.15(4): 373–380. Published online 2012 Dec 31. doi: 10.4048/jbc.2012.15.4.373 {accessed November 2015}

    2. Nursing and Midwifery Council, The Code March 2015

    5.2 Summary of evidence, review and recommendations

    The information contained within these guidelines have been collated from reputable services. Attention has been paid to ensure seroma drainage is safe for both patients and staff. . An annual appraisal to ensure safe practice and competence of the Breast Specialist Nurse is essential.

    Seroma formation and drainage can bring about patient anxiety and may delay further treatment. It is vital the Breast Specialist Nurse spend time in explainingthe procedure and address the patient's anxieties.

    6. Appendices

    Document Owner Sonnya Dabill 
    Review Date
    Document Status
    Revision Number