Value of Mechanical Closure of Dead Space after Mastectomy in Reducing Postoperative Drainage and Seroma Formation

Abstract

Breast cancer is the most common female cancer and the second leading cause of cancer death among women. The surgical treatment of choice for these patients is either modified radical mastectomy or breast conservation depending upon stage of disease. Seroma formation is the most frequent post operative complication after breast cancer surgery. It occurs in most patients after mastectomy. Seroma is a pocket of clear serous fluid that develops in the body after surgery. Seroma is thought to be caused by the fact that the mastectomy operation leaves a lot of an "empty space" under the skin where the breast tissue used to be. The walls around this empty space are raw and can ooze serous fluid causing it to gather up in the space beneath the wound.Seroma is commonly managed by frequent daily aspiration. Seroma formation can result in many complications; including its being annoying to the patient giving a sensation of discomfort and repeated skin puncture is necessary to remove the seroma. In addition to many ambulatory visits this also leads to an increased risk of infection, and the adjuvant treatment can be delayed for several weeks. Further more, prolonged seroma formation may be associated with delayed wound healing and increased risk of skin flap neerosis, infection, and lymphoedema of the arm. The pathophysiology and mechanism of seroma formation is still unclear. Although it is obscure whether seroma is composed of lymph-like fluid or an inflammatory exudate. Further study is needed to gain a better understanding of the pathophysiology of seroma .As there are some studies which have shown characteristics of lymph and others have shown characteristics of inflammatory exudates. There are several risk factors which control the incidence of post mastectomy seroma formation including factors related to patients and tumor characteristics (as increased patient age, weight, diseases as diabetes, hypertension, cancer staging and grading and the general body condition), surgical factors, postoperative factors and non-surgical modalities (including;chemotherapy and radiotherapy).