A novel surgical approach to treat lymphangioma of the breast and prevent seroma—a case report

Background: Lymphangiomas are benign lymphatic tumours which are histologically composed of networks of endothelium-lined spaces. Lymphangioma of the breast is extremely rare, with few cases described in the literature. In previously published case reports, surgical excision has been a successful treatment modality. There is no evidence of successful management with aspiration or steroid injection. There is a paucity of evidence describing surgical techniques to reduce post-operative seroma formation and achieve acceptable cosmesis in cases of lymphangioma, and no comments relating to patient satisfaction. This case describes a novel surgical approach, not previously described, to treat of lymphangioma of the breast, with particular attention to the application of quilting sutures which reduces the dead space within the cavity to reduce the risk of seroma formation and maintain acceptable cosmesis. Case Description: This 44-year-old female presented with a left breast lump. Ultrasound revealed a 79 mm cyst and magnetic resonance imaging (MRI) described a large fluid collection in the left upper outer quadrant extending into the axilla to lie under pectoralis major. Cytology showed lymphoid-rich fluid with no atypical cells. Following multiple attempts of aspiration, with subsequent re-accumulation of fluid over a period of 14 months, this patient underwent complete surgical excision of the lesion with quilting using a barbed 2/0 Stratafix suture. Multiple Stratafix sutures were placed loosely throughout the cavity in multiple layers to obliterate the space. The use of Stratafix in this setting is novel and contributed to the patients rapid recovery. There was complete resolution of the lesion with no complications or recurrence. The patient was very satisfied with the outcome in terms of cosmesis and reduced discomfort. Conclusions: We propose that surgical excision is the definitive treatment of breast lymphangioma and the use of quilting prevents seroma formation and maintains acceptable cosmesis.