Efficacy of axillary exclusion on seroma formation after modified radical mastectomy

Abstract

Background: Breast cancer represented 35.1% of total female cancer cases in Egypt. Seroma is one of the most serious and common complications of mastectomy and axillary dissection with incidence between 15 and 81%. Seroma formation delays wound healing and increases susceptibility to infection, skin flap necrosis, and persistent pain as well as prolonging convalescence. Therefore, several techniques have been investigated to minimize seroma formation with no consistent success. Axillary exclusion is a technique aimed to obliterate dead space after axillary clearance and minimize collection.

Methods: Sixty-four patients were prepared for modified radical mastectomy. Of those, the study group contains 32 patients and the control group contains 32 patients. Study group had axillary exclusion while the other had the conventional procedure; total drain outputs were recorded daily for all patients prior to drain removal. The drains were removed when the daily drainage was less than 30 ml.

Results: This study contains 64 patients, the study group contains 32 patients, and the control group contains 32 patients. Age, BMI (mean control=31.7 and study=30.2), and tumor size were of no significant differences to be more concise on the effect of axillary exclusion. The mean of day of drain removal in the control group was 17.8 day (15-19) with a mean of total drain output of 4525.6 ml (4430-3660 ml) while the mean in the study group of day of drain removal was 11.3 (10-13) with a mean of total drain output of 1476.2 ml (620-2200 ml), p<0.00.

Conclusions: Axillary exclusion technique is a valuable procedure that significantly decreases seroma postmastectomy and axillary dissection.

Fig. 1

Study intra operative images show (a) axillary fossa after mastectomy and axillary clearance and (b) axillary exclusion: the technique was performed by a single surgeon and involved skin flap dissection and the excision of the breast with pectoral fascia, and the dissection of axillary lymph nodes were performed with a diathermy (a). Control of the small bleeding vessels was sustained with coagulate mood of diathermy. Suturing the superior mastectomy skin flap down to the free edge of pectoralis major and the lateral chest wall was done using a continuous 2/0 vicryl stitch, and then, four to six interrupted sutures were placed between pectoralis major and minor to reliably exclude the axillary fossa from the remainder of the mastectomy cavity (b)

Fig. 2

Distribution of patients according to daily drain output (ml). Significant reduction of the daily amount of the seroma in the study group who underwent axillary exclusion, p < 0.05

Fig. 3

Distribution of patients according to postoperative complications. For the distribution of the participants according to the list of postoperative complications in both groups, in the study group, there was 91.2 % of patients with no postoperative complications, 5.9 % developed wound infection, 2.9 % developed ischemic flaps, and there was no one developed reaccumulation or wound dehiscence while the control group showed 73.8 % of patients with no postoperative complications, 11.7 % developed infection, 8.8 % developed ischemic flaps, 2.9 % reaccumulation, and 2.9 % developed wound dehiscence