Abstract
Breast cancer is a socially relevant group of malignant conditions of the mammary gland, affecting both males and females. Most commonly the surgical approach of choice is a modified radical mastectomy (MRM), due to it allowing for both the removal of the main tumor mass and adjacent glandular tissue, which are suspected of infiltration and multifocality of the process, and a sentinel axillary lymph node removal. Most common post-surgical complications following MRM are the formation of a hematoma, the infection of the surgical wound and the formation of a seroma. These post-surgical complications can, at least in part, be attributed to the drainage of the surgical wound. However, the lack of modern and official guidelines provides an ample scope for innovation, but also leads to a need for a randomized comparison of the results. We compared different approaches to wound drainage after MRM, reviewed based on the armamentarium, number of drains, location, type of drainage system, timing of drain removal and no drainage alternatives. Currently, based on the general results, scientific and comparative discussions, seemingly the most affordable methodology with the best patient outcome, with regards to hospital stay and post-operative complications, is the placement of one medial to lateral (pectoro-axillary) drain with low negative pressure. Ideally, the drain should be removed on the second or third postoperative day or when the amount of drained fluid in the last 24 hours reaches below 50 milliliters.
Highlights
BackgroundBreast cancer is a socially relevant group of malignant conditions of the mammary gland, affecting both males and females, showing a tendency for development after the third decade and increasing its incidence with age, peaking in the fourth and fifth decade [1,2,3,4,5]
The approach of choice for the treatment of breast cancer is based on its clinical staging
Most commonly the approach of choice is a modified radical mastectomy (MRM), due to it allowing for both the removal of the main tumor mass and adjacent glandular tissue, which are suspected of infiltration and multifocality of the process, and a sentinel axillary lymph node removal [9,10]
Summary
Breast cancer is a socially relevant group of malignant conditions of the mammary gland, affecting both males and females, showing a tendency for development after the third decade and increasing its incidence with age, peaking in the fourth and fifth decade [1,2,3,4,5]. Fibrin-based and other type of tissue sealants in the process of closing the surgical wound in some of the procedures have resulted in significantly lower incidence of seroma in those patients compared to other drained and undrained patients [36]. The lack of drainage discomfort and pain for the patient, as well as the risk of postoperative infections, have given further commercial rise to these claims These types of procedures generally allow for an earlier hospital discharge and limit the emotional traumatism for the patient. Encouraging, these results are reported only in a small case series, when compared to other options. While the short-term effects on hospital stay and postoperative complication between all drainage options have been compared, albeit in small cohorts for some methodologies, the long-term effects of drainage on subsequent formation of deep scar tissue and long-term restoration of mobility in these areas have not been compared on a wider scale
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