Refractory chronic seroma following latissimus dorsi flap breast reconstruction successfully treated by surgical excision: A case report

Chronic seroma is a common complication following latissimus dorsi (LD) flap breast reconstruction, but prolonged, treatment-resistant cases are rare. We report a case of a refractory seroma that developed in the early postoperative period and persisted for over four years despite 79 aspirations (including 37 combined with corticosteroid injections and 5 minocycline sclerotherapy sessions). The patient eventually underwent surgical excision of the fibrous capsule at 48 months postoperatively, with the assistance of intraoperative indigo carmine dye to facilitate accurate capsule delineation. Histopathology revealed a dense fibrous wall with chronic inflammation, and no malignancy or infection. Postoperatively, a compression garment was used for six months. At 16-month follow-up, there was no recurrence. This case highlights the importance of early recognition and surgical consideration in managing chronic seromas unresponsive to conservative therapy. Surgical excision combined with compression may achieve excellent long-term outcomes and improve patient quality of life.