The online version of this article (doi:10.1186/1477-7819-10-8) contains supplementary material, which is available to authorized users.
The authors declare that they have no competing interests.
The author conceived and design the study, performed surgery. The author, also write the manuscript and approved it after final revision.
Prolonged and excessive drainage of serous fluid and seroma formation constitute the most common complications after mastectomy for breast carcinoma. Seroma formation delays wound healing, increases susceptibility to infection, skin flap necrosis, persistent pain and prolongs convalescence. For this, several techniques have been investigated to improve primary healing and minimize seroma formation.
Between June 2009 and July 2010 forty patients with breast carcinoma, scheduled for modified radical mastectomy, were randomly divided into 2 groups, the study group (20) and the control group (20). In the study group; the mastectomy flaps were fixed to the underlying muscles in raws, at various parts of the flap and at the wound edge using fine absorbable sutures. In the control group; the wound was closed in the conventional method at the edges. Closed suction drains were used in both groups. Patients, tumor characteristics and operative related factors were recorded. The amount and color of drained fluid were recorded daily. The drains were removed when the amount become less than 50 cc. The total amount and duration of drained fluid and the formation of seroma were recorded and the results were compared between the two groups.
In the flap fixation group, the drain was removed in significantly shorter time compared to the control group (p < 0.001). Also, the total amount of fluid drained was significantly lower in the flap fixation group (p < 0.001). The flap fixation group showed a significantly lower frequency of seroma formation compared to the control group, both clinically (p = 0.028) and ultrasonographically (p = 0.047).
The mastectomy flap fixation technique is a valuable procedure that significantly decreases the incidence of seroma formation, and reduces the duration and amount of drained fluid. However, it should be tried on a much wider scale to prove its validity.
Woodworth PA, McBoyle MF, Helmer SD, Beamer RL: Seroma formation after breast cancer surgery: incidence and predicting factors. Am Surg. 2000, 66: 444-50. discussion 450-51 PubMed
Say CC, Donegan W: A biostatistical evaluation of complications from mastectomy. Surg Gynecol Obstet. 1974, 138: 370-76. PubMed
Watt-Boolsen S, Nielsen VB, Jensen J, Bak S: Postmastectomy seroma. A study of the nature and origin of seroma after mastectomy. Dan Med Bull. 1989, 36: 487-9. PubMed
Roberto Ruggiero MD, Eugenio Procaccini MD, Pasquale Piazza MD: Effectiveness of fibrin glue in conjunction with collagen patches to reduce seroma formation after axillary lymphadenectomy for breast cancer. The American Journal of Surgery. 2008, 196: 170-174. 10.1016/j.amjsurg.2007.09.042. CrossRefPubMed
Miller E, Paull DE, Morrissey K, Cortese A, Nowak E: Scalpel versus electrocautery in modified radical mastectomy. Am Surg. 1988, 54: 284-6. PubMed
Petrek JA, Peters MM, Cirrincione C, Thaler HT: A prospective randomized trial of single versus multiple drains in the axilla after lymphadenectomy. Surg Gynecol Obstet. 1992, 175: 405-9. PubMed
Coveney EC, O'Dwyer PJ, Geraghty JG, O'Higgins NJ: Effect of closing dead space on seroma formation after mastectomy--a prospective randomized clinical trial. Eur J Surg Oncol. 1993, 19: 143-146. PubMed
Aitken DR, Hunsaker R, James AG: Prevention of seromas following mastectomy and axillary dissection. Surg Gynecol Obstet. 1984, 158: 327-330. PubMed
O'Dwyer PJ, O'Higgins NJ, James AG: Effect of closing dead space on incidence of seroma after mastectomy. Surg Gynecol Obstet. 1991, 172: 55-56. PubMed
Chilson TR, Chan FD, Lonser RR, Wu TM, Aitken DR: Seroma prevention after modified radical mastectomy. Am Surg. 1992, 58: 750-754. PubMed
Garnier JM, Hamy A, Classe JM, Laborde O, Sagot P, Lopes P, Boog G, Drianno JC, Guillard Y: A new approach to the axilla: functional axillary lymphadenectomy and padding. J Gynecol Obstet Biol Reprod(Paris). 1993, 22: 237-242.
Purushotham AD, McLatchie E, Young D, George WD, Stallard S, Doughty J, Brown DC, Farish C, Walker A, Millar K, Murray G: Randomized clinical trial of no wound drains and early discharge in the treatment of women with breast cancer. Br J Surg. 2002, 89: 286-292. 10.1046/j.0007-1323.2001.02031.x. CrossRefPubMed
Tadych K, Donegan WL: Postmastectomy seromas and wound drainage. Surg Gynecol Obstet. 1987, 165: 483-7. PubMed
Ackroyd R, Reed MWR: A prospective randomized trial of the management of suction drains following breast cancer surgery with axillary clearance. The Breast. 1997, 6: 271-4. 10.1016/S0960-9776(97)90003-5. 29 CrossRef
Hoefer RA, DuBois JJ, Ostrow LB, Silver LF: Wound complications following modified radical mastectomy: an analysis of perioperative factors. J Am Osteopath Assoc. 1990, 90: 47-53. PubMed
- The value of mastectomy flap fixation in reducing fluid drainage and seroma formation in breast cancer patients
Mostafa A Sakkary
- BioMed Central
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