Post-Surgical Seroma and Deferred Fitting
A 49-year-old woman is referred for a prosthesis fitting 5 weeks after right mastectomy with sentinel node biopsy. At the visit she reports a feeling of fullness and sloshing in the right chest area, and you observe a soft, fluid-filled swelling along the lower incision line. The skin is intact but taut and mildly erythematous. She has a low-grade temperature of 37.8 C and reports increasing discomfort over the past two days. She is eager to be fitted today because she has a family event in three days and wants to look symmetrical. She has brought a tight, non-pocketed bra she hopes to wear.
1. What is your immediate course of action regarding the fitting, and why?
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The swelling, sloshing sensation, taut skin, low-grade fever, and increasing discomfort suggest a possible seroma, and the mild erythema and fever raise concern for infection. This is outside the fitting scope and warrants prompt referral to the surgeon or treating clinician before any prosthesis fitting. Do not proceed with a tight bra or a weighted form over a fluid collection, as pressure can worsen symptoms and skin integrity. Explain your concern clearly and without alarming her, contact the surgical office if she agrees, and document the findings, the referral, and her understanding. Offer to reschedule the fitting after the clinician evaluates the area, and discuss temporary camouflage options that do not compress the chest.
2. She insists on something for the family event in three days. What safe interim options could you discuss?
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If the clinician clears her, a lightweight foam form or a soft fabric filler in a loose, non-compressive top can provide visual balance without pressure on the seroma. Avoid a tight band, an underwire, or a heavy silicone form until the fluid collection resolves. Suggest clothing with draping or a scarf to soften the silhouette, and a soft camisole if it does not press on the incision. Emphasize that comfort and healing take priority, and set a follow-up fitting after the clinician's assessment. Document the interim advice and the reasons for deferral.