Quilting following mastectomy reduces seroma, associated complications and health care consumption without impairing patient comfort

Abstract

Background An important complication following mastectomy is seroma formation. Quilting, in which skin flaps are sutured to the underlying muscle, is reported to reduce seroma incidence, but might induce pain and impair shoulder function. Main objective is to compare quilting with conventional wound closure, regarding seroma incidence, health care consumption, and patient discomfort. Methods In a combined prospective and retrospective study, 254 patients undergoing mastectomy and/or axillary lymph node dissection (ALND) were included. Patients received quilting sutures or conventional closure. Primary outcome was clinical significant seroma (CSS). In prospectively included patients shoulder function and analgesic use was observed. Results CSS incidence was 12.9% in the quilted versus 62.3% in the nonquilted cohort (p < 0.001). Surgical site infections were reported significantly less in the quilted cohort. Duration of hospital stay was shorter and outpatient clinic visits were less in the quilted cohort. Surgical procedure required 10 additional minutes for quilting. No significant differences were observed in postoperative shoulder function and analgesic use. Conclusion Quilting following mastectomy reduces CSS incidence. Quilting requires 10 additional minutes during surgery. It facilitates day treatment and results in less additional outpatient clinic visits culminating in reduced health care consumption. Shoulder function and pain are not affected by quilting.

Technical aspects of flap fixation after mastectomy for breast cancer: Guidelines for improving seroma‐related outcome

“…5 The SAM-trial showed that shoulder mobility seems to be equally affected in patients undergoing mastectomy with or without flap fixation using sutures. 10,15,16 There was a gradual decrease in shoulder mobility disability scores in all groups after mastectomy, suggesting that shoulder mobility in general worsens after mastectomy. Cosmesis and especially skin dimpling do not seem to differ between groups.…”

“…Methods vary in technique (running or interrupted), suture size (Vicryl 0 to 3-0), distance between sutures (2-5 cm), and location. 2,3,6,8,10,[12][13][14][15] The results of this article should be used to provide a clear guideline on how to perform flap fixation when using sutures.…”

“…Previous studies raised some concerns regarding shoulder mobility and cosmesis after flap fixation 5 . The SAM‐trial showed that shoulder mobility seems to be equally affected in patients undergoing mastectomy with or without flap fixation using sutures 10,15,16 . There was a gradual decrease in shoulder mobility disability scores in all groups after mastectomy, suggesting that shoulder mobility in general worsens after mastectomy.…”

Using Drain-Free Flap Fixation Techniques Versus Traditional Wound Closure With Drain Placement to Prevent Seroma Formation and Its Complications in Breast Cancer Patients Undergoing Mastectomy: A Systematic Review and Meta-analysis

“…We additionally evaluated the incidence of hematoma after breast cancer surgery. We discovered 11 studies that evaluated hematoma (Eichler et al, 2016; Huang et al, 2021; Khater et al, 2015; Mazouni et al, 2015; Myint et al, 2020; Ohlinger et al, 2018; Ouldamer et al, 2015; van Bastelaar et al, 2016; van Zeelst et al, 2022; Vettuparambil & Subramanya, 2021; Wu et al, 2020) as an outcome when comparing flap fixation and drain placement techniques in breast cancer patients undergoing mastectomy representing a population of 1,735 (SG = 798 patients [46%]; CG = 937 patients [54%]). The results of the meta-analysis were not statistically significant but did show a reduction in the rate of hematoma formation in the SG compared with the CG (OR = 0.78; 95% CI [0.6, 1.03]; p = .08).…”

“…We reviewed a total of 3,176 articles, screened a total of 304 studies, and analyzed a total of 19 studies that met our inclusion criteria. The studies were conducted between 2010 and 2022, one of which we imported only a few days before conducting our analysis (van Zeelst et al, 2022).…”