Reply: Seroma in Prosthetic Breast Reconstruction

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We thank Dr. Hwang for his interest in our article on seroma and prosthetic breast reconstruction.1 Briefly, to clarify our search methods, we used “seroma” AND (“breast” OR “tissue expander” OR “implant” OR “reconstruction”), and included a manual search of reference lists identified by this search to be broadly inclusive. The elimination of references from 810 articles, resulting in 51 articles, is clearly described in the Results section (albeit not in pictorial form).
We agree with Dr. Hwang’s assertion that the evidence on seroma associated with acellular dermal matrix use continues to evolve with time and changing practice patterns. We noted a high degree of heterogeneity in our review and in fact remarked that the results of our own meta-analysis from 2012 (relative risk, 2.73; 95 percent CI, 1.67 to 4.46) differed from the updated meta-analysis performed in this 2016 article (relative risk, 1.83; 95 percent CI, 1.28 to 2.72).
Regarding drain use for preventing seroma, we emphasize that although this is a compilation of practices from experienced, published groups, few studies have been specifically designed to examine the impact of drains on seroma. Thus, several variables such as breast size, criteria for removal, use of compression dressings, intraoperative expander fill, and position of drains remained relatively uncontrolled. As such, the available data were simply presented, and we do not feel the quality of the studies warrants any firm conclusion (as we note in the Discussion section). Until prospective, randomized clinical trials of seroma prevention practices are generated, there will continue to be uncertainty over appropriate drain management in diverse clinical contexts.
We appreciate Dr. Hwang’s ad hoc graphic analysis of seroma with acellular dermal matrix by publication year. We think this is the starting point to further discourse on seroma and acellular dermal matrix, and we are glad our article could provide a forum for him to present this initial finding.

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