Elastofibroma dorsi: determinants of symptom burden, bilaterality, and perioperative morbidity in 102 surgically treated patients

Elastofibroma dorsi (ED) is a rare, benign, tumor-like soft-tissue lesion typically located in the subscapular region. Despite having a characteristic radiological appearance, clinical presentation and early postoperative course may vary from patient to patient. This study aimed to describe the clinical and pathological characteristics of surgically treated ED and to explore factors associated with symptom burden and early postoperative course (seroma and length of stay). We conducted a retrospective analysis of 102 patients who underwent surgical resection for histopathologically confirmed ED between January 2010 and June 2025. Data on demographics, symptom profiles, occupational history, imaging and pathological measurements, early postoperative course (seroma and length of hospital stay) were collected and analyzed. Women constituted 85% of patients (n = 87), and the average age was 61.5 ± 7.9 years. Seventy-five (73.5%) were symptomatic, and 51 (50%) had bilateral ED. The most common occupation was homemaker (62.7%), and the most prevalent comorbidity was hypertension (36.3%). Postoperative seroma occurred in 19 (18.6%) patients. Symptomatic patients were significantly younger (p < 0.001), more likely to have bilateral lesions (p < 0.001), and had larger pathological tumor volumes (p = 0.023) and areas (p = 0.002). In multivariable analysis, female sex (OR 0.136 for male sex; 95% CI, 0.033–0.564; p = 0.008) and younger age (OR 0.933 per year; 95% CI, 0.881–0.988; p = 0.017) were independently associated with bilateral disease. Lesions were predominantly located ipsilateral to the dominant hand (p < 0.001). Seroma development was exclusive to symptomatic patients (p = 0.009) and was associated with longer symptom duration (p = 0.027). In contrast, length of hospital stay correlated with preoperative tumor volume (rho = 0.411; p < 0.001) and area (rho = 0.401; p < 0.001). Symptom burden in elastofibroma dorsi was associated with disease burden, particularly bilaterality and larger pathological tumor dimensions. Postoperative seroma was associated with clinical factors (symptomatic presentation and longer symptom duration), whereas length of stay correlated mainly with tumor size. These findings may support individualized perioperative counseling and risk stratification in surgically treated patients. ClinicalTrials.gov, NCT07010224. Registered on 30 May 2025. Retrospectively registered.