Is flap fixation an effective technique for reduction of postmastectomy seroma?

Abstract

Background: Seroma formation after breast cancer surgery cannot be avoided, but it can possibly be decreased by closing of the dead space surgically. Prospective trials have established that flap fixation after mastectomy, and consequently dead space diminution, can be very valuable.Methods: A clinical trial done in Sohag University Hospital. All patients undergoing mastectomy or modified radical mastectomy for invasive breast cancer or ductal carcinoma in situ (DCIS) were eligible for inclusion and divided into two groups: The control group (C) From, patients had conventional wound closure; and flap fixation group (FF) where patients underwent wound closure using flap fixation.Results: We found that the mean blood loss was significantly higher among C group compared to only 41 ml among FF group. Regarding seroma formation, the total number of patients developed seroma showed non-significant difference between the two groups; while the number of seroma requiring aspiration was significantly higher among C group (48%) compared to FF group (20%). Regarding skin dimpling, it was mild and temporary in the minority of FF group cases, persisted in only 8% of cases after 6 months postoperative. Shoulder mobility was normal in the vast majority of cases in the early postoperative period (28% among C group and 40% among FF group); and all of these cases returned to normal shoulder mobility after 6 months of physiotherapy.Conclusions: This study demonstrates that reduction of the dead space after mastectomy using flap fixation reduces seroma formation and seroma aspirations without significant rise in the complications such as skin dimpling and shoulder mobility limitations.