BackgroundSeroma formation is a common complication following mastectomy for invasive breast cancer. Mastectomy flap fixation is achieved by reducing dead space volume using interrupted subcutaneous sutures.MethodsAll patients undergoing mastectomy due to invasive breast cancer or ductal carcinoma in situ (DCIS) were eligible for inclusion. From May 2012 to March 2013, all patients undergoing mastectomy in two hospitals were treated using flap fixation. The skin flaps were sutured on to the pectoral muscle using polyfilament absorbable sutures. The data was retrospectively analysed and compared to a historical control group that was not treated using flap fixation (May 2011 to March 2012).ResultsOne hundred and eighty patients were included: 92 in the flap fixation group (FF) and 88 in the historical control group (HC). A total of 33/92 (35.9 %) patients developed seroma in the group that underwent flap fixation; 52/88 (59.1 %) patients developed seroma in the HC group (p = 0.002). Seroma aspiration was performed in 14/92 (15.2 %) patients in the FF group as opposed to 38/88 (43.2 %) patients in the HC group (p < 0.001).ConclusionsFlap fixation is an effective surgical technique in reducing dead space and therefore seroma formation and seroma aspirations in patients undergoing mastectomy for invasive breast cancer or DCIS.

Background Seroma formation is a common complication following mastectomy for invasive breast cancer. Seroma formation can cause problems in wound healing and infection, thus leading to seroma aspirations and repeated visits to the out-patient clinic. The key to reducing seroma formations seems to partly lie in the obliteration of dead space. However, the techniques used to achieve this goal are subjects of much controversy and debate. Mastectomy flap fixation (FF) is achieved by reducing dead space volume using interrupted subcutaneous sutures. We hypothesized that obliteration of the dead space following mastectomy would significantly reduce seroma formation, resulting in fewer outpatient visits and seroma aspirations. This study, aiming to reduce seroma formation after mastectomy, is a retrospective study that compared conventional mastectomy with mastectomy and flap fixation. Methods All patients undergoing mastectomy due to invasive breast cancer were eligible for inclusion. From May 2012 – March 2013 all patients undergoing mastectomy in 2 hospitals were treated using flap fixation. The skin flaps were sutured on to the pectoral muscle using polyfilament absorbable sutures. The data was retrospectively analyzed and compared to a historical control group (HC) that was not treated using flap fixation (May 2011 – March 2012). In the HC group, only the skin was sutured. Closed suction drainage was applied to all patients in both groups. Results 180 patients were included; 92 in the FF group and 88 in the HC group. There were no significant differences in patient demographics. 36% of patients developed seroma in the group that underwent flap fixation; 59% of patients developed seroma in the historical control group (P=0.002). Seroma aspiration was performed in 15% of patients in the flap fixation group as opposed to 43% of patients in the control group (P&lt;0.001). Multivariate analysis showed that the effect of flap fixation varied with the extent of surgery: whereas flap fixation reduced seroma formation in patients undergoing simple mastectomy or mastectomy with sentinel node recovery, FF did not reduce seroma formation in patients undergoing mastectomy with axillary lymph node dissection (i.e. modified radical mastectomy; P=0.04 for interaction. Effects of flap fixation on seroma formation stratified by operation type Historical ControlFlap fixationPMastectomy8/14 (57%)1/6 (17%)0.16Mastectomy and SN26/42 (62%)13/52 (25%)&lt;0.001Modified Radical Mastectomy18/32 (56%)19/34 (56%)0.98 In contrast, flap fixation was associated with fewer seroma aspirations in all types of surgery (P=0.80 for interaction). Effects of flap fixation on seroma aspiration stratified by operation type Historical ControlFlap fixationPMastectomy6/14 (43%)1/6 (17%)0.35Mastectomy and SN19/42 (45%)7/52 (14%)0.001Modified Radical Mastectomy13/32 (41%)6/34 (18%)0.04 Conclusion Patients undergoing mastectomy flap fixation displayed a significant reduction in seroma formation and fewer patients were subjected to seroma aspiration. Patients undergoing flap fixation required fewer seroma aspirations. Flap fixation is an effective surgical technique in reducing dead space and therefore seroma formation in patients undergoing mastectomy for IBC. Citation Format: James Van Bastelaar, Arianne Beckers, Maarten Snoeijs, Yvonne Vissers. Flap fixation reduces seroma in patients undergoing mastectomy: A significant implication for clinical practice [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P2-13-28.