Closed suction drainage has been used to prevent seroma formation after lumpectomy and axillary node dissection for breast cancer. To study the efficacy of closed suction drains, the authors conducted a prospective randomized study from 1987 to 1990 of 227 axillary dissections. One hundred eight were randomized to a drain group (DG) and 119 to a no drain group (NDG). Drains were removed on the first postoperative day just before patient discharge. Postoperatively, all palpable axillary collections were aspirated on each follow-up visit. The volume aspirated, the number of aspirations, the time to seroma resolution, and all complications were recorded. The mean number of aspirations in the DG was significantly lower than the NDG (2.2 +/- 2.2 versus 3.3 +/- 2.1; p less than or equal to 0.002). Mean volume aspirated in the DG (146.3 +/- 181.1 mL) was less than the NDG (266.1 +/- 247.6 mL; p less than or equal to 0.003), and the time to seroma resolution was decreased in the DG as compared with the NDG (11.5 +/- 10 days versus 18 +/- 10.1 days; p less than or equal to 0.0002). Closed suction drainage after lumpectomy and axillary node dissection is advantageous in decreasing the incidence and degree of seroma formation and need not delay early hospital discharge.

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Treatment results of leptomeningeal metastasis are reported in 33 breast cancer patients. They were divided into three groups: group 1, 19 patients, received intraventricular methotrexate (MTX) with doses based on CSF MTX levels; group 2, 6 patients, received whole brain radiation followed by a course of MTX given by lumbar punctures; group 3, 8 patients, was not treated. Median survival in group 1 was 6 months; 25% survived 1 year or more. Median survival (1 to 2 months) in groups 2 and 3 was significantly shorter. Neurologic improvement was seen in an average time of 4 weeks in about 80% of group 1 patients. Two of group 2 patients improved at 3 weeks, and all group 3 patients deteriorated. Carcinomatosis caused death significantly less often in group 1 than in the other groups.