Seroma prevention after mastectomy: a scoping review of literature and protocol for a Delphi study among Dutch surgical oncologists
5 affiliations
- 1Department of Surgery, Zuyderland Medical Center, Sittard-Geleen, The Netherlands
- 2Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Centre+, Maastricht, The Netherlands
- 3Department of Surgery, Isala Zwolle, Zwolle, The Netherlands
- 4Department of Surgery, Maastricht University Medical Centre+, Maastricht, The Netherlands
- 5GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
Abstract
Introduction Mastectomy is notorious for seroma formation, with an incidence of up to 85%. The development of seroma can cause pain and may lead to complications such as surgical site infections, wound dehiscence or skin(-flap) necrosis. Depending on the extent of seroma formation and related complications, interventions such as aspiration, antibiotics or surgery may be necessary.Extensive research into preventive methods to reduce seroma formation has been performed. Surgical techniques and materials are thought to be of vital importance regarding seroma formation. Preventive measures such as tissue dissection technique, wound closure to reduce dead space, postoperative drain use, systemic anti-inflammatory drugs and external compression provide conflicting results and were described in a scoping review of the literature. The optimal (combination of) technique(s) has not yet been established.The aim of this study is to reach consensus regarding seroma preventive measures after mastectomy, to reduce the incidence of seroma and its sequelae.Methods and analysis This study will be conducted as a modified Delphi process amongst surgical oncologists in the Netherlands specialised in breast cancer surgery. This study will focus on mastectomy, with or without sentinel lymph node biopsy, excluding patients undergoing direct breast reconstruction or axillary lymph node dissection.The following steps will be taken:(1) A scoping review of literature will be conducted to identify various seroma preventive measures following the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines and Arksey and O’Malley Framework for scoping reviews; (2) drafting statements for a Delphi questionnaire; (3) questionnaire round and validation of statements by Delphi panel and (4) final recommendations.Steps 2 and 3 of this Delphi process will be conducted for a maximum of three rounds, or until consensus on all subjects has been reached. After each subsequent round, an interim analysis will be conducted to address consensus and non-consensus issues. Non-consensus issues will be presented in subsequent survey rounds, accompanied by findings from the former survey round. Final recommendations will be made regarding the optimal combination of seroma preventive measures in mastectomy.Ethics and dissemination Prior to starting this study, the hospital’s medical ethical committee granted non-WMO approval for this study (ID: METCZ20240061; approval date 3 September 2024). Digital informed consent will be obtained from all participants (surgical experts). No patients are involved in this study. The dissemination strategy for this Delphi study is designed to translate the expert consensus into clinical practice. The final recommendations of this study are intended for optimisation of breast (cancer) surgery standards in the Netherlands, and inform the broader international oncological community. The results from this Delphi study can be used to implement seroma prevention techniques in current clinical practice and national guidelines.Discussion A scoping review was performed as an outline for the Delphi protocol. The use of a national network for the Delphi study maximises participation and controls attrition bias, which aids in the trustworthiness of the eventual results. The engagement of the expert panel will further guide the homogenisation of seroma prevention in mastectomy.
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BibTeX
@article{servaas2026seroma,
title = {{Seroma prevention after mastectomy: a scoping review of literature and protocol for a Delphi study among Dutch surgical oncologists}},
author = {Nick Servaas and Merel A Spiekerman van Weezelenburg and Loeki Aldenhoven and Merel Kimman and Jean H T Daemen and Martinus A Beek and Elisabeth R M van Haaren and Alfred Janssen and Yvonne L J Vissers and Geerard L Beets and James van Bastelaar},
journal = {BMJ Open},
year = {2026},
month = oct,
doi = {10.1136/bmjopen-2025-107778},
url = {https://bmjopen.bmj.com/lookup/doi/10.1136/bmjopen-2025-107778},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Seroma prevention after mastectomy: a scoping review of literature and protocol for a Delphi study among Dutch surgical oncologists
AU - Nick Servaas
AU - Merel A Spiekerman van Weezelenburg
AU - Loeki Aldenhoven
AU - Merel Kimman
AU - Jean H T Daemen
AU - Martinus A Beek
AU - Elisabeth R M van Haaren
AU - Alfred Janssen
AU - Yvonne L J Vissers
AU - Geerard L Beets
AU - James van Bastelaar
PY - 2026
DA - 2026/10/27
JO - BMJ Open
DO - 10.1136/bmjopen-2025-107778
UR - https://bmjopen.bmj.com/lookup/doi/10.1136/bmjopen-2025-107778
AB - Introduction Mastectomy is notorious for seroma formation, with an incidence of up to 85%. The development of seroma can cause pain and may lead to complications such as surgical site infections, wound dehiscence or skin(-flap) necrosis. Depending on the extent of seroma formation and related complications, interventions such as aspiration, antibiotics or surgery may be necessary.Extensive research into preventive methods to reduce seroma formation has been performed. Surgical techniques and materials are thought to be of vital importance regarding seroma formation. Preventive measures such as tissue dissection technique, wound closure to reduce dead space, postoperative drain use, systemic anti-inflammatory drugs and external compression provide conflicting results and were described in a scoping review of the literature. The optimal (combination of) technique(s) has not yet been established.The aim of this study is to reach consensus regarding seroma preventive measures after mastectomy, to reduce the incidence of seroma and its sequelae.Methods and analysis This study will be conducted as a modified Delphi process amongst surgical oncologists in the Netherlands specialised in breast cancer surgery. This study will focus on mastectomy, with or without sentinel lymph node biopsy, excluding patients undergoing direct breast reconstruction or axillary lymph node dissection.The following steps will be taken:(1) A scoping review of literature will be conducted to identify various seroma preventive measures following the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines and Arksey and O’Malley Framework for scoping reviews; (2) drafting statements for a Delphi questionnaire; (3) questionnaire round and validation of statements by Delphi panel and (4) final recommendations.Steps 2 and 3 of this Delphi process will be conducted for a maximum of three rounds, or until consensus on all subjects has been reached. After each subsequent round, an interim analysis will be conducted to address consensus and non-consensus issues. Non-consensus issues will be presented in subsequent survey rounds, accompanied by findings from the former survey round. Final recommendations will be made regarding the optimal combination of seroma preventive measures in mastectomy.Ethics and dissemination Prior to starting this study, the hospital’s medical ethical committee granted non-WMO approval for this study (ID: METCZ20240061; approval date 3 September 2024). Digital informed consent will be obtained from all participants (surgical experts). No patients are involved in this study. The dissemination strategy for this Delphi study is designed to translate the expert consensus into clinical practice. The final recommendations of this study are intended for optimisation of breast (cancer) surgery standards in the Netherlands, and inform the broader international oncological community. The results from this Delphi study can be used to implement seroma prevention techniques in current clinical practice and national guidelines.Discussion A scoping review was performed as an outline for the Delphi protocol. The use of a national network for the Delphi study maximises participation and controls attrition bias, which aids in the trustworthiness of the eventual results. The engagement of the expert panel will further guide the homogenisation of seroma prevention in mastectomy.
SN - 2044-6055
SN - 2044-6055
ER -