Assessment of Mastectomy Flap Fixation in Reducing the Seroma Formation in Breast Carcinoma Patients

Abstract

Breast carcinoma is a major health issue in modern society. The National Cancer Institute in the USA estimates that 12.7% of women born today will be diagnosed with breast carcinoma during the course of their lifetime. Breast carcinoma can impact patients psychologically as well as organically, which can manifest as post mastectomy depression, increased anxiety, shame and occasional ideas of suicide. Breast carcinoma is usually treated with surgery, chemotherapy or radiation, or both. Treatment is given with increasing aggressiveness according to the prognosis and risk of recurrence. Seroma is formed by acute inflammatory exudates in response to surgical trauma and acute phase of wound healing. Extensive dissection in mastectomy and axillary lymphadenectomy damage several blood vessels and lymphatics with subsequent oozing of blood and lymphatic fluid from a larger raw surface area (when compared with breast-conserving procedures) leads to seroma formation. Fluid accumulation elevates the flaps from the chest wall and axilla thereby hampering their adherence to the chest wall bed and delay healing. Seroma and prolonged, excessive drainage of serous fluid constitute the most common complications after mastectomy for breast carcinoma. The reported incidence of seroma formation varies between 15 and 81%. Seroma formation increases the risk of post operative complications; delays wound healing, ceullitis, increases susceptibility to infection, skin flap necrosis, persistent pain and wound dehiscence and prolongs convalescence Ideal wound closure should minimize lymph spillage and serum oozing, provide a means of holding skin flaps securely to the chest wall structures, obliterate dead space, and allow rapid removal of fluid as it forms. For this, several techniques of flap fixation or wound drainage, as well as limitation of postoperative shoulder movement and the use of adhesive glue, have been investigated to improve primary healing and minimize seroma formation. The findings of the literature review and based on our experience, it is suggested that the flap fixation technique is a valuable procedure that significantly decrease the total amount of drained fluid, allowing the earlier removal of the drains as well as decreasing the incidence of seroma formation, and the need for frequent visits for seroma fluid aspiration after mastectomy. However, this technique should be tried on a much wider scale to prove its validity in decreasing the incidence of seroma formation and its subsequent complications, so that it can be introduced as a step in the mastectomy operations.