Being a doctor and doing hundreds of breast procedures, we get a lot of exposure to what is normal and expected, versus what is rare and atypical. However, when you’re on the patient side of things and your experience is essentially (hopefully) just once, everything is strange, weird, and atypical…. And therefore, must be abnormal or unique to just your situation, right?
Here are some fairly common situations that can arise after surgery and breast procedures, a brief explanation of why they’re occurring, and things to worry about versus things that you can expect:
Seromas are caused by fluid leaking from the raw surfaces of divided tissue. For example, if you have a scrape on your skin, this will dry into a crusty scab, but if the surfaces are trapped under the skin, and the fluid can’t evaporate or flow away, it has an opportunity to accumulate under the tissue, this can make a collection called a seroma.
Seromas happen in every surgery, it’s just a question of how large they can get, and how long they can last. It is a product of how quickly the body seals the surfaces and re-absorbs the fluid versus how fast the fluid leaking is. If there is an imbalance, the fluid can accumulate into a collection that either requires drain placement or drainage through the skin. Giving the fluid a place to leave via a drain tube will decrease the chance of seroma accumulation.
Seromas can be there for a prolonged time, usually more than 3 to 4 weeks, and can keep coming back. But they are not considered bad or dangerous. It is common to have to have drains in place for one to two weeks after surgery to give the tissues enough time to stick together and heal.
Problematic, long-term, or recurrent seromas, need to be addressed if they are symptomatic, associated with infections, or uncomfortable for the patient. Otherwise, some people have long-term retained seromas that have no side effects and don’t necessarily need to be cured or addressed. This isn’t common but it can happen.
Redness, often, is not an active infection, but rather likely to occur when tissue has increased blood supply from healing. This can be warm, purplish red, versus infection redness, which looks more like a sunburn or an orange, salmon-colored red. Wounds that are infected usually feel better, then begin to hurt, and become more sensitive, instead of stabilizing and healing.
Incisions that are not fully closed can leak healthy dead cells and some fluid as they try to clean themselves. This gooey substance is called “fibrinous exudate” in medical terms. It is not pus, and it is not considered an infection.
It is certainly possible to have germs in and around a wound that is healing, but not have it be infected, in the same sense that you have germs living in your mouth and on your nose but have no infections there. Performing culture testing on healing healthy-appearing wounds without signs of infection is usually not helpful.
Suture material that is used to close wounds typically dissolves over time. Sometimes the body sees this as a foreign body and wants to push it out. This could cause a bump in the scar line that sometimes creates a little wound and unevenness temporarily.
Some of that gooey “fibrinous exudate” can sometimes come out of the wound site. It is not pus, and it is not infected, it is called “spitting” and typically once the material has been gently pulled out by your doctor, or kicked out by your body, it should heal normally afterward.
Certain tapes or dressings, especially a clear non-stretchy dressing, called Tegaderm, can cause blisters on the edges of where the dressing was applied. This is not an allergic reaction, but rather a physical reaction from the pulling of the tape on the skin.
If you have an allergic reaction to wound care, it should be a large irritating red square everywhere the dressing was touching and maybe beyond, not just a small or linear (usually) painless blister near the edge.
A keloid scar is when the healing process overtakes the boundaries of where the wound is created and overgrows the site of the scar: a raised scar. People who have tightening or thickening of a scar that is discolored or feels firm, typically have a hypertrophic scar. This can be frustrating, but it is not necessarily considered a keloid scar.
There are various scar treatment options available to patients. One is using silicone pads that create a bit of pressure and essentially ask the tissue to remodel itself. Many doctors have techniques that gently re-traumatize scar tissue with procedures like microneedling or laser therapy that can help soften and encourage the body to remodel the tissue.
Remember that if you have a tight, uncomfortable type of scar that is unsightly, healing usually is hard, lumpy, and tight for many weeks to months after the initial procedure. With more time and even no additional effort, things can improve.