ABS ePoster Library

BACKGROUND: One of the most invalidating complications after breast cancer surgery is seroma formation. The incidence of seroma formation after breast surgery varies from 3% to 85% [1,2] .Seroma formation and inadequate drainage of seroma may lead to infections, pain, hospitalization and delay in treatment [3] .Methods employed to prevent seromata include suction drainage, shoulder immobilization, quilting sutures, fibrin sealants.
AIM: To determine the effect of a 'no drains' policy on seroma formation and other complications in women undergoing breast cancer surgery and to evaluate the effect of obliteration of dead space by suture fixation of the mastectomy flaps to the underlying chest wall, on the amount and duration of postoperative fluid drainage and incidence of seroma formation after breast surgery.
MATERIALS AND METHODS: A retrospective analysis was performed on a consecutive series of patients that had been treated with Mastectomy with or without axillary surgery for breast cancer for the last 1 year.
Patients divided into Group 1 the wound was closed in the conventional method at the edges and closed suction drains are used.Group 2; after completing the mastectomy procedure, using absorbable sutures(vicryl ), continuous stitches 3 cm apart were taken, in rows, between the subcutaneous tissues of the skin flaps and the underlying muscles. Special attention is taken to the obliteration of the largest potential dead space, the empty axillary apex. Closed suction drains are used.Group 3 similar procedure but no drain used.
The Patient characteristics collected were: age, type of surgery, side of the affected breast, , neoadjuvant chemotherapy, diabetes, body mass index (BMI), smoking, , anticoagulants usage and length of hospital stay.
Definitions
Postoperative haematoma: clear postoperative haematoma formation in the area of the operation, for which intervention is necessary.
Wound infection: clinical signs of infection (pain, swelling, erythema, fever, exudate, delayed wound healing or breakdown), purulent discharge or a positive microbiological culture.
Seroma production: palpable fluid collection, with serous consistency, produced subcutaneous in the area of operation or axilla
RESULTS: 113 women were included in the study. women underwent modified radical mastectomy (MRM) and ALND , MRM ± sentinel lymph node biopsy (SLNB) /axillary node sampling (ANS) and simple Mx .There was no significant difference between the studied groups concerning the age, type of surgery, side of the affected breast, , neoadjuvant chemotherapy, diabetes, body mass index (BMI), smoking, , anticoagulants usage.
There were six patients with evacuation of haematoma postoperativlely and belongs to group 1 and 2 with drains.The number (and percentage) of women with wound infection was none in the group1, 8 in gp 2 and 2 among gp 3 patients.
Seroma formation was 10 in gp1 ,9in gp 2 and 4 in gp 3 .
The length of hospital stays(days) was 2.7 in gp1 .2.6 in gp 2 and 1.3 days in gp 3 patients with no drains (ND).
CONCLUSION: This study investigated that wound drainage following Mastectomy could be avoided by suturing flaps to the underlying chest wall,therby facilitating early discharge with no associated increase in surgical morbidity.
This study suggests that MRM ± ALND/SLNB/ANS can be performed without the use of suction drains without increasing seroma formation and other complication rates. Adopting a 'no-drains' policy may also contribute to earlier hospital discharge.
Ref[1] S. Kumar, B. Lal, M.C. Misra, Post-mastectomy seroma: a new look into the aetiology of an old problem, J. R. Coll. Surg. Edinb 40 (1995) 292e294.
[2] V. Srivastava, S. Basu, V.K. Shukla, Seroma formation after breast cancer surgery: what we have learned in the last two decades, J. Breast Cancer 15 (4) (2012) 373e380.
[3] D.R. Shamley, K. Barker, V. Simoite, A. Beardshaw, Delayed versus immediate exercises following surgery for breast cancer: a systematic review, Breast Cancer Res. Treat 90 (2005) 263e271.