CC BY-NC-ND 4.0 · Arch Plast Surg 2022; 49(04): 494-500
DOI: 10.1055/s-0042-1751103
Original Article

Comparing Seroma Formation at the Deep Inferior Epigastric Perforator, Transverse Musculocutaneous Gracilis, and Superior Gluteal Artery Perforator Flap Donor Sites after Microsurgical Breast Reconstruction

1   Faculty of Medicine, University of Zurich, Zurich, Switzerland
2   Plastic Surgery Group, Zurich, Switzerland
3   Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Basel, Switzerland
4   Department of Computer Science and Statistics, Poznan University of Medical Sciences, Poznan, Poland
3   Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Basel, Switzerland
2   Plastic Surgery Group, Zurich, Switzerland
5   University of Basel, Basel, Switzerland
› Author Affiliations
Funding None.


Background Seroma formation is the most common donor site complication following autologous breast reconstruction, along with hematoma. Seroma may lead to patient discomfort and may prolong hospital stay or delay adjuvant treatment. The aim of this study was to compare seroma rates between the deep inferior epigastric perforator (DIEP), transverse musculocutaneous gracilis (TMG), and superior gluteal artery perforator (SGAP) donor sites.

Methods The authors conducted a retrospective single-center cohort study consisting of chart review of all patients who underwent microsurgical breast reconstruction from April 2018 to June 2020. The primary outcome studied was frequency of seroma formation at the different donor sites. The secondary outcome evaluated potential prognostic properties associated with seroma formation. Third, the number of donor site seroma evacuations was compared between the three donor sites.

Results Overall, 242 breast reconstructions were performed in 189 patients. Demographic data were found statistically comparable between the three flap cohorts, except for body mass index (BMI). Frequency of seroma formation was highest at the SGAP donor site (75.0%), followed by the TMG (65.0%), and DIEP (28.6%) donor sites. No association was found between seroma formation and BMI, age at surgery, smoking status, diabetes mellitus, neoadjuvant chemotherapy, or DIEP laterality. The mean number of seroma evacuations was significantly higher in the SGAP and the TMG group compared with the DIEP group.

Conclusion This study provides a single center's experience regarding seroma formation at the donor site after microsurgical breast reconstruction. The observed rate of donor site seroma formation was comparably high, especially in the TMG and SGAP group, necessitating an adaption of the surgical protocol.

Author Contributions

A.M. performed data collection, statistical analysis, and drafted and revised the manuscript. N.E.S. assisted in designing the project and wrote all drafts and revisions. M.M. performed statistical analysis and assisted to revise the manuscript. D.J.S. assisted to revise the manuscript. J.F. designed the project of this article and assisted to write all drafts and revisions. All authors read and approved the final manuscript.

Ethical Approval

All procedures performed within this study were in accordance with the ethical standards of the institutional and national research committee, as well as with the 1964 Helsinki Declaration and its later amendments. Given that this study was conducted in the context of an audit as part of a quality improvement assessment, no specific approval was needed, as confirmed by the local medical ethics committee (BASEC-Nr. 2020–00609).

Patient Consent

The patients provided written consent in accordance with institutional policies.

Publication History

Article published online:
30 July 2022

© 2022. The Korean Society of Plastic and Reconstructive Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (

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