Breast cancer surgery, and in particular axillary lymphadenectomy, has changed in the last few years with the advent of the sentinel lymph node technique [
11]. However, even today there are a number of situations where a conventional axillary lymphadenectomy is indicated, including patients with tumours greater than 3 cm in diameter, with positive or suspect axillary lymph nodes based on an objective examination and an instrumental diagnosis, or with a positive sentinel lymph node. In this group of patients, the axillary lymphadenectomy still has complications, in particular seroma formation (15-81%)[
1‐
5], which can delay the patient's discharge, healing and supplementary radiotherapy and chemotherapy treatments. The formation of seroma can result from a lesion of the axillary lymphatic vessels [
2] or from an inflammatory reaction [
17], which may also be prolonged and intensified by the continuance of suction drainage. The removal of drainage for some surgeons is indicated when the volume per day is less than 50 ml
2, but we prefer to remove the drainage when the volume per day is less than 100 ml, since in our experience drains do not prevent seroma formation, and they also dictate the date of discharge, resulting in a longer stay [
3]. A number of surgeons believe that it is possible to discharge patients with the drainage
in situ [
3] despite the associated discomfort and increase in percentage infection rate. This issue of drainage management in the home arises in cases of procedures carried out in day surgery. Many published articles on the usefulness of drainage following axillary lymphadenectomy contradict each another with regard to seroma control, magnitude and duration. Porter
17reported a non-significant difference in the incidence and degree of seroma between patients with suction drainage (73%)
versus patients without suction drainage (89%). Divino [
4] reported a 6% incidence of seroma for patients with drainage, compared with 40% for patients without. Burak [
19] noted a relationship between seroma magnitude and patient age. Jeffrey [
20] reported a 92% seroma incidence in patients without drainage, and sharing the view of others that repeated suctions may be the cause of infections of the axillary fossa [
21‐
25], applied evacuative puncture only in symptomatic cases (42%). In terms of the methods of reducing seroma magnitude, there have been numerous reports of the benefits of using an external compression dressing [
26], immobilization of the arm [
27], use of sutures to close the axillary fossa [
28], excessive use of the electric scalpel compared to ligature of the lymphatic branches [
29,
30], benefits of multiple drains[
21], and the type of suction (high- or low-pressure) applied [
31]. The use of fibrin glue has also produced contrasting results: reduction of seroma according to Moore and Gilly [
11,
26] no difference in seroma formation compared with patients treated without fibrin glue, according to Burak [
19], Langer [
27] and Dinsmore [
28]. The latter Authors attributed the lack of benefit to the presence of drainage possibly interfering with the stabilization of a fibrin clot, and with closure of the lymphatic capillaries. Fibrin glue interacts with the tissues damaged during the surgical procedure, favoring the growth of fibroblasts and wound healing. It favors hemostasis by preventing hematomas, which delay the surgical healing processes; makes the lymphatic branches impermeable, reducing seroma formation; and makes it possible to close the dead spaces through tissue adhesion. A number of papers have presented comparative studies of patients with and without fibrin glue in the axillary fossa. In a study of 24 patients who underwent quadrantectomy or mastectomy with axillary lymphadenectomy, In a group of 20 patients who underwent quadrantectomy with axillary lymphadenectomy, Jain [
29] reported a seroma incidence of around 40%, with a reduction in seroma magnitude in mastectomy patients upon whom fibrin glue was used. Although a significant difference was not observed between quadrantectomy patients treated with or without fibrin glue. The study demonstrated that suction drainage did not limit the incidence or magnitude of seromas, and that it was associated with extended time spent in hospital and post-operative pain. Soon [
30] showed that, among patients who underwent quadrantectomy or mastectomy with axillary lymphadenectomy, there was no difference in terms of the incidence of seromas with or without the use of suction drainage, and that, for the group of patients without drainage, the seromas formed in greater magnitude and for a longer duration, but with a lower percentage of complications. Kuroi [
31] in a Medline search about one meta-analysis, 51 randomized controlled trials, 7 prospective studies and 7 retrospective studies showed that there was moderate evidence to support a risk for seroma formation in individuals with heavier body weight, extended radical mastectomy and greater drainage volume in the initial 3 days; with regard to the use of adhesive glue many retrospective studies failed to show any significant effect on seroma formation. Based on our experience and reviewing data from the literature [
3,
10,
21,
31‐
37], it seems that the magnitude and duration of the seromas are limited, but they are present in over 80% of patients, without significant differences between mastectomy and quadrantectomy. Use of harmonic scalpel can reduce the magnitude of seromas and acute blood loss after axillary dissection [
38‐
48]. The use of fibrin glue may therefore be useful, in our opinion, in traditional breast cancer surgery for reducing seroma magnitude and duration, and shortening the stay in hospital which, in this pathology too, is increasingly conducted in day surgery.