Study on prevention of axillary seroma formation after modified radical mastectomy

OBJECTIVE: To analyze the risk factors of axillary seroma formation and explore the methods of reducing the axillary drainage volume and duration after modified radical mastectomy.METHODS: Retrospectively analyzed 105 patients from January 2007 to December 2008 who has undergone modified radical mastectomy.The source of the axillary seroma and the related risk factors on seroma formation were investigated.Seven factors related to seroma formation were analyzed with Logistic regression to identify the risk factors.The 152 patients were subdivided into three groups: suture ligation group(n=51),the operations were performed by clamp-and-tie techniques with axillary reconstruction;UAS group(n=50),the operations were performed by using the harmonic scalpel with axillary reconstruction;electrocautery group(ELC,n=51),the operations were performed by monopolar electric scalpel with axillary reconstruction.Age and clinical stage of tumor of the three groups were similar.Major indexes to observe and compare included drainage volume and duration and incidence of seroma.RESULTS: Thirdty-two patients(30.48%) developed an axillary seroma in retrospective group.The reasons of seroma formation mainly included lymphorrhea 46.9%and exudative hydrops 37.5%.Multivariate analysis using logistic regression model showed that diabetes(OR=4.520),number of metastatic lymph nodes(OR=3.762) and early postoperative shoulder exercise(OR=2.939) independently correlated with seroma formation.The incidence of the suture ligation group was 3.92%,similar to UAS group 4%(P=0.800),significantly lower than that in ELC group 17.64%(P=0.051) and the retrospective group 30.48%(P=0.000).Axillary reconstruction could effectively close the axillary fossa space and reduce the total drainage volume.A thorough lymphatic ligation could reduce duration of drainage.CONCLUSION: Lymphorrhea and exudation are the main reasons for seroma formation. A thorough lymphatic ligation and the eradication of residual axillary cavity may be the key to prevention of seroma formation.