Seroma formation following axillary dissection for breast cancer: risk factors and lack of influence of bovine thrombin

Abstract

Background: Seromas of the axillary space following breast surgery can lead to significant morbidity and delay in the initiation of adjuvant therapy. A prospective, randomized study was undertaken to evaluate the effect of bovine spray thrombin on seroma formation following either modified radical mastectomy (MRM) or lumpectomy with axillary dissection (LAD). In addition, risk factors for seroma formation were analyzed and identified.

Methods: A total of 101 patients were randomized to receive either bovine thrombin (20,000 units) (treatment group) or no thrombin (control group) applied to their axilla following either MRM or LAD. Drains were left in place until the preceding 24-hour drainage was < 40 milliliters. The number of days the drains were in place and wound complications (including seroma formation) were recorded.

Results: Forty-nine (n = 49) patients were assigned to the treatment gorup and 52 (n = 52) to the control group. MRM was performed on 60 patients (59%) and LAD oN 41 (41%). Eighteen of the 49 patients (37%) in the thrombin group developed a seroma in comparison to 21 of the 52 control patients (40%) (P = 0.71). Significant risk factors for seroma formation included increased age, patient weight, initial 72-hour wound drainage, and LAD. No statistically significant differences were observed between treatment and control groups with respect to time to drain removal, or the incidence of other wound complications.

Conclusion: Although thrombin by itself appears to have no effect on subsequent seroma development following axillary dissection, the identification of predictive variables will be helpful in designing future trials aimed at reducing the incidence of this common complication of breast surgery.