The value of mastectomy flap fixation in reducing fluid drainage and seroma formation in breast cancer patients

Abstract

BackgroundProlonged 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.Materials and methodsBetween 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.ResultsIn 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).ConclusionsThe 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.

Role of quilting technique of mastectomy flap in prevention and reduction of seroma complication in breast cancer patients

“…Regarding the amount of seroma required aspiration among patients treated with both arm technique, this study was comparable with several authors who showed significantly less drainage in the quilting group when compared to the nonquilting group [28][29][30]. There was significant association between presence of seroma and level of clearance this may be due to removal of a larger number of lymph nodes which results in greater injury of the lymph vessels.…”

“…The technique of obliteration of dead space, therefore seem to be advantageous by tacking of mastectomy flaps to the pectoralis muscle and fascia. Several authors also reported that the incidence of seroma was significantly lower in the quilting group compared with the non-quilting group [28][29][30].…”

Should a Drain Be Placed in Early Breast Cancer Surgery?

“…1). Articles investigating different instruments/surgical techniques [25,26,27], postsurgical physiotherapy [28], or breast infections without relation to the insertion of drains [29,30] were excluded. This left the 3 articles from Taylor et al [5], Andeweg et al [31], and Garbay et al [32].…”

Quilting Suture of Mastectomy Dead Space Compared with Conventional Closure with Drain

“…5,[14][15][16][17][18] More recently, quilting has been proposed, with some technical variations, to reduce the rate of seroma after mastectomy with the concomitant use of drains at the pectoral area. [19][20][21][22][23][24] However, to our knowledge, there has been no assessment of quilting suture as a method to reduce the incidence of seroma after mastectomy without the use of drains in the pectoral area. 25 Our main objective of this study was to compare quilting suture of the ''dead space'' without drainage of the pectoral area to conventional closure with drainage, on postoperative seroma formation in women undergoing mastectomy for breast cancer.…”