Background: Seroma formation following breast surgery can significantly impact recovery, morbidity, and adjuvant therapy timing. This study evaluates the role of comorbidities (diabetes mellitus and hypertension) and nutritional status (serum albumin) in the development of seroma post-Modified Radical Mastectomy (MRM). Methods: This prospective study involved 100 patients undergoing MRM at a tertiary care hospital in North India. Comorbidities (diabetes, hypertension), hematological parameters (hemoglobin, leukocyte count), and serum albumin levels were recorded. Patients were monitored postoperatively for seroma formation over a 3-week period. Results: Of the 100 patients, 26% developed seroma. The incidence of seroma was significantly higher among diabetics (58.33%) and hypertensives (60.71%) compared to non-diabetics and normotensives (p<0.001). Serum albumin <3.5 g/dL was associated with a seroma rate of 73.08%, also statistically significant. No correlation was found with hemoglobin or leukocyte count. Conclusion: Diabetes, hypertension, and hypoalbuminemia are significant predictors of seroma formation post-MRM. Optimizing systemic and nutritional status may reduce postoperative morbidity and enhance recovery.
Seroma, the accumulation of serous fluid in surgical dead space, is a frequent complication of MRM. Though not life-threatening, it can prolong hospital stay, delay adjuvant therapy, and increase infection risk. Patient-related risk factors, particularly systemic comorbidities and nutritional deficiencies, may significantly influence seroma development. This study focuses on the association of comorbidities and serum albumin levels with postoperative seroma.
Study Design: Prospective observational study
Location: Department of General Surgery, Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar
Duration: August 2023 to February 2025
Sample Size: 100 patients undergoing MRM
Inclusion Criteria: Patients undergoing MRM for breast carcinoma
Exclusion Criteria: Patients with fungating tumors
Data recorded included comorbidities (diabetes, hypertension), hemoglobin, total leukocyte count, and serum albumin. Seroma was identified by clinical examination and managed by aspiration if needed.
Table 1: Association of Comorbidities and Seroma Formation
|
Comorbidity |
Seroma (%) |
No Seroma (%) |
p-value |
|
Diabetes Mellitus |
58.33 |
41.67 |
<0.001 |
|
Hypertension |
60.71 |
39.29 |
<0.001 |
Table 2: Albumin Level and Seroma Formation
|
Albumin Level (g/dL) |
Seroma (%) |
No Seroma (%) |
p-value |
|
<3.5 |
73.08 |
20.27 |
<0.001 |
|
≥3.5 |
26.92 |
79.73 |
|
Table 3: Hemoglobin and Leukocyte Count vs Seroma
|
Parameter |
Association with Seroma |
p-value |
|
Hemoglobin |
Not Significant |
>0.05 |
|
Total Leukocyte Count |
Not Significant |
>0.05 |
Figure 1: Seroma Incidence by Diabetes
Figure 2: Seroma Rate Based on Albumin Levels (Pie chart or bar chart comparing <3.5 vs ≥3.5 g/dL)
Figure 1: Seroma Incidence by Diabetes
Figure 3: Seroma Incidence by Diabetes
The findings affirm that diabetes and hypertension significantly impair postoperative wound healing, possibly due to microvascular changes and delayed immune responses. Hypoalbuminemia, a marker of poor nutritional status, contributes to impaired tissue repair and increased dead space fluid accumulation. These associations have also been reported by Pan et al. and Chaudhary et al.
Routine evaluation of serum albumin and stringent management of comorbidities should be part of preoperative planning. Hemoglobin and leukocyte count were not useful predictors in this study.
Comorbidities and hypoalbuminemia are strong, independent predictors of seroma post-MRM. Their correction before surgery may enhance patient outcomes and reduce hospital burden.
Conflict of Interest
None declared.
Funding
No external funding received.
Acknowledgment
We thank the faculty and staff of the General Surgery Department, SGRD Institute.
Author Contributions
K.S.: Data collection, analysis, writing
A.K.G.: Supervision, review
R.S.: Concept and final approval
AI Disclosure
No AI-assisted technologies were used in manuscript preparation.
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