Back
 ABCR  Vol.7 No.1 , January 2018
“Axillary Space Obliteration”—An Effective Technique in Reducing Seroma Formation after Mastectomy and Axillary Dissection
Abstract: Introduction: Seroma is the commonest complication of breast cancer surgery, and although its consequences most often cause no more than discomfort and anxiety, more important sequelae include flap necrosis and wound dehiscence. Seroma management can be difficult and frustrating for both the patient and surgeon. Numerous methods to reduce post-mastectomy seroma formation have been tried with no consistent success. Methods: Sixty patients were prepared for modified radical mastectomy. Of those, the study group contains 30 patients and the control group contains 30 patients. Study group had axillary space obliteration 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 60 patients, and the study group contains 30 patients, and the control group contains 30 patients. Age, tumor size, No. of positive lymph nodes were of no significant differences to be more concise on the effect of axillary space obliteration. The mean of day of drain removal in the control group was 13.2 ± 1.0 days (9 - 18 days) with a mean of total drain output of (4700 ± 90.3 ml) (3722 - 4930) while the mean in the study group of day of drain removal was 7.1 ± 1.3 days (6 - 12) with a mean of total drain output of 1530 ± 422 ml (range 600 - 2100 ml) p < 0.001. Conclusion: Obliteration of axillary space is a valuable procedure that significantly decreases seroma after mastectomy and axillary dissection.
Cite this paper: Elbalshy, M. , Fayed, A. and Hagag, M. (2018) “Axillary Space Obliteration”—An Effective Technique in Reducing Seroma Formation after Mastectomy and Axillary Dissection. Advances in Breast Cancer Research, 7, 23-32. doi: 10.4236/abcr.2018.71003.
References

[1]   Aitken, D.R. and Minton, J.P. (1983) Complications Associated with Mastectomy. Surgical Clinics of North America, 63, 1331-1352.
https://doi.org/10.1016/S0039-6109(16)43192-0

[2]   Woodworth, P.A., McBoyle, M.F., Helmer S.D. and Beamer, R.L. (2000) Seroma Formation after Breast Cancer Surgery: Incidence and Predicting Factors. The American Journal of Surgery, 66, 444-451.

[3]   Roses, D.F., Brooks, A.D., Harris, M.N., et al. (1999) Complications of Level I and II Axillary Dissection in the Treatment of Carcinoma of the Breast. Annals of Surgery, 230, 194-201.
https://doi.org/10.1097/00000658-199908000-00009

[4]   Iida, S., Furukawa, K., Yanagihara, K., et al. (2008) An Analysis of Factors That Influence the Duration of Suction Drainage in Breast Cancer Surgery. Journal of Nippon Medical School, 75, 332-336.
https://doi.org/10.1272/jnms.75.332

[5]   Lumachi, F., Brandes, A.A., Burelli, P., Basso, S.M., Iacobone, M. and Ermani, M. (2004) Seroma Prevention Following Axillary Dissection in Patients with Breast Cancer by Using Ultrasound Scissors: Aprospective Clinical Study. European Journal of Surgical Oncology, 30, 526-530.
https://doi.org/10.1016/j.ejso.2004.03.003

[6]   Saeb-Parsy, K., Athanassoglou, V. and Benson, J.R. (2006) Talc Seromadesis: A Novel Technique for the Treatment of Chronic Seromas Following Breast Surgery. The Breast Journal, 12, 502-504.
https://doi.org/10.1111/j.1075-122X.2006.00317.x

[7]   Gonzales, E.A., Saltzstein, E.C., Riedner, C.S. and Nelson, B.K. (2003) Seroma Formation Following Breast Cancer Surgery. The Breast Journal, 9, 385-388.
https://doi.org/10.1046/j.1524-4741.2003.09504.x

[8]   Hashemi, E., Kaviana, A., Najafi, M., Ebrahimi, M., Hooshmand, H. and Montazeri, A. (2004) Seroma Formation after Surgery for Breast Cancer. World Journal of Surgical Oncology, 2, 44.
https://doi.org/10.1186/1477-7819-2-44

[9]   Pogson, C.J., Adwani, A. and Ebbs, S.R. (2003) Seroma Following Breast Cancer Surgery. European Journal of Surgical Oncology, 29, 711-717.
https://doi.org/10.1016/S0748-7983(03)00096-9

[10]   Purkayastha, J., Hazarika, S., Deo, S.V., Kar, M. and Shukla, N.K. (2004) Post-Mastectomy Chylous Fistula: Anatomical and Clinical Implications. Clinical Anatomy, 17, 413-415.
https://doi.org/10.1002/ca.10239

[11]   Lindsey, W.H., Masterson, T.M., Spotnitz, W.D., Wilhelm, M.C. and Morgan, R.F. (1990) Seroma Prevention Using Fibrin Glue in a Rat Mastectomy Model. Archives of Surgery, 125, 305-307.
https://doi.org/10.1001/archsurg.1990.01410150027005

[12]   Moore, M.M., Nguyen, D.H. and Spotnitz, W.D. (1997) Fibrin Sealant Reduces Serous Drainage and Allows for Earlier Drain Removal after Axillary Dissection: A Randamiosed Prospective Trial. The American Journal of Surgery, 63, 97-103.

[13]   Classe, J.M., Berchery, D., Campion, L., et al. (2006) Randomized Clinical Trial Comparing Axillary Padding with Closed Suction Drainage for the Axillary Wound after Lymphadenectomy for Breast Cancer. British Journal of Surgery, 93, 820-824.
https://doi.org/10.1002/bjs.5433

[14]   Halsted, W.S. (1913) Developments in the Skin Grafting Operations for Cancer of the Breast. Journal of the American Medical Association, 60, 416-418.
https://doi.org/10.1001/jama.1913.04340060008004

[15]   Coveney, E.C., O’Dwyer, P.J., Geraghty, J.G. and O’Higgins, N.J. (1993) Effect of Closing Dead Space on Seroma Formation after Mastectomy—A Prospective Randomised Clinical Trial. European Journal of Surgical Oncology, 19, 143-146.

[16]   O’Dwyer, P.J. (1991) Axillary Dissection in Primary Breast Cancer. British Medical Journal, 302, 360-361.
https://doi.org/10.1136/bmj.302.6773.360

[17]   Chilson, T.R., Chan, F.D., Lonser, R.R., Wu, T.M. and Aitken, D.R. (1992) Seroma Prevention after Modified Radical Mastectomy. American Surgeon, 58, 750-754.

[18]   Garnier, J.M., Hamy, A., Classe, J.M., Laborde, O., Sagot, P., Lopes, P., et al. (1993) A New Approach to the Axilla: Functional Axillary Lymphadenectomy and Padding. Journal of Gynaecology, Obstetrics and Reproductive Biology, 22, 237-242.

[19]   Classe, J.M., Dupre, P.F., Francois, T., Robard, S., Theard, J.L. and Dravet, F. (2002) Axillary Padding as an Alternative to Closed Suction Drain for Ambulatory Axillary Lymphadenectomy: A Prospective Cohort of 207 Patients with Early Breast Cancer. Archives of Surgery, 137, 169-172.
https://doi.org/10.1001/archsurg.137.2.169

[20]   Benjasirichai, V., Piyapant, A., Pokawattana, C. and Dowreang, J. (2007) Reducing Postoperative Seroma by Closing of Axillary Space. Journal of the Medical Association of Thailand, 90, 2321-2325.

[21]   Gong, Y., Xu, J., Shao, J., Cheng, H., Wu, X., Zhao, D., et al. (2010) Prevention of Seroma Formation after Mastectomy and Axillary Dissection by Lymph Vessel Ligation and Dead Space Closure: A Randomized Trial. The American Journal of Surgery, 200, 352-356.
https://doi.org/10.1016/j.amjsurg.2009.10.013

[22]   Chand, N., Aertssen, A.M.G. and Royle, G.T. (2013) Axillary “Exclusion”—A Successful Technique for Reducing Seroma Formation after Mastectomy and Axillary Dissection. Advances in Breast Cancer Research, 2, 1-6.
https://doi.org/10.4236/abcr.2013.21001

[23]   Faisal, M., Abu-Elela, S.T., Mostafa, W. and Antar, O. (2016) Efficacy of Axillary Exclusion on Seroma Formation after Modified Radical Mastectomy. World Journal of Surgical Oncology, 14, 39.
https://doi.org/10.1186/s12957-016-0801-0

 
 
Top