Is flap fixation an effective technique for reduction of postmastectomy seroma?
DOI:
https://doi.org/10.18203/2349-2902.isj20195378Keywords:
Flap fixation, Seroma and mastectomy, Seroma aspirationsAbstract
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.
References
Baker M. Breast Cancer: Surgical Management. In: Cameron JL, Cameron AM, eds. Current surgical therapy. 11th ed. USA: Elsevier Saunders; 2014: 568-71.
Aitken DR, Minton JP. Complications associated with mastectomy. Surg Clin North Am. 1983;63(6):1331-52.
Tanaka S, Hayek G, Jayapratap P, Yerrasetti S, Hilaire HS, Sadeghi A, et al. The impact of chemotherapy on complications associated with mastectomy and immediate autologous tissue reconstruction. Am Surg. 2016;82(8):713-7.
Woodworth PA, McBoyle MF, Helmer SD, Beamer RL. Seroma formation after breast cancer surgery: incidence and predicting factors. Am Surgeon. 2000;66(5):444-50.
Abe M, Iwase T, Takeuchi T, Murai H, Miura S. A randomized controlled trial on the prevention of seroma after partial or total mastectomy and axillary lymph node dissection. Breast Cancer. 1998;5(1):67-9.
Pogson CJ, Adwani A, Ebbs SR. Seroma following breast cancer surgery. Eur J Surgical Oncol. 2003;29(9):711-7.
Porter KA, O'Connor S, Rimm E, Lopez M. Electrocautery as a factor in seroma formation following mastectomy. Am J Surg. 1998;176(1):8-11.
Coons MS, Folliguet TA, Rodriguez C, Woloszyn TT, Tuchler RE, Marini CP. Prevention of seroma formation after dissection of musculocutaneous flaps. Am Surg. 1993;59(4):215-8.
Daltrey I, Thomson H, Hussien M, Krishna K, Rayter Z, Winters ZE. Randomized clinical trial of the effect of quilting latissimus dorsi flap donor site on seroma formation. Br J Surg. 2006;93(7):825-30.
van Bemmel AJ, van de Velde CJ, Schmitz RF, Liefers GJ. Prevention of seroma formation after axillary dissection in breast cancer: a systematic review. Eur J Surgical Oncol. 2011;37(10):829-35.
Almond LM, Khodaverdi L, Kumar B, Coveney EC. Flap anchoring following primary breast cancer surgery facilitates early hospital discharge and reduces costs. Breast Care. 2010;5(2):97-101.
Matsui Y, Yanagida H, Yoshida H, Imamura A, Kamiyama Y, Kodama H. Seroma with fibrous capsule formation requiring a surgical resection after a modified radical mastectomy: report of a case. Surg Today. 1998;28(6):669-72.
Qvamme G, Axelsson CK, Lanng C, Mortensen M, Wegeberg B, Okholm M, et al. Randomized clinical trial of prevention of seroma formation after mastectomy by local methylprednisolone injection. Br J Surg. 2015;102(10):1195-203.
Srivastava V, Basu S, Shukla VK. Seroma formation after breast cancer surgery: what we have learned in the last two decades. J Breast Cancer. 2012;15(4):373-80.
van Bastelaar J, Beckers A, Snoeijs M, Beets G, Vissers Y. Flap fixation reduces seroma in patients undergoing mastectomy: a significant implication for clinical practice. World J Surgical Oncol. 2016;14:66.
Wolde B, van den Wildenberg FJ, Keemers-Gels ME, Polat F, Strobbe LJ. Quilting prevents seroma formation following breast cancer surgery: closing the dead space by quilting prevents seroma following axillary lymph node dissection and mastectomy. Ann Surg Oncol. 2014;21(3):802-7.
Kuroi K, Shimozuma K, Taguchi T, Imai H, Yamashiro H, Ohsumi S, et al. Effect of mechanical closure of dead space on seroma formation after breast surgery. Breast Cancer. 2006;13(3):260-5.
van Bastelaar J, Granzier R, van Roozendaal LM, Beets G, Dirksen CD, Vissers Y. A multi-center, double blind randomized controlled trial evaluating flap fixation after mastectomy using sutures or tissue glue versus conventional closure: protocol for the seroma reduction after mastectomy (SAM) trial. BMC Cancer. 2018;18(1):830.
van Bastelaar J, Theunissen LLB, Snoeijs MGJ, Beets GL, Vissers YLJ. Flap fixation using tissue glue or sutures appears to reduce seroma aspiration after mastectomy for breast cancer. Clin Breast Cancer. 2017;17(4):316-21.
Sakkary MA. The value of mastectomy flap fixation in reducing fluid drainage and seroma formation in breast cancer patients. World J Surgical Oncol. 2012;10:8.
Jabir MA, Taha A, Shehata MR, Sayed MM, Yehia A. Post-mastectomy seroma: does dead space obliteration have a protective effect?. Breast Cancer Current Res. 2017;3(1):1-6.
