Is there any benefit in routine wound drainage following mastectomy and axillary clearance?.

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Abstract Abstract #4153 Introduction: Seromas are the most frequent complication of breast cancer surgery and are often considered a "necessary evil". Despite limited evidence, suction drains are routinely used to reduce their risk. Drains are an important factor contributing to increased hospital stay as patients are usually reluctant to be discharged before their removal. The aim of this study was to compare the seroma rate post mastectomy and axillary clearance with and without insertion of suction drains. Methods: All patients undergoing mastectomy and axillary clearance treated under the care of three consultant breast surgeons were studied. Data was collected prospectively and analysed retrospectively. Outcome measures included incidence and volume of postoperative seroma, number of aspirations, length of stay and complication rate. Mann-Whitney U test and difference between proportions was used for statistical analysis. Results: Between December 2006 and March 2008 a total of 74 women, median age 63 (range 44-88) underwent 78 mastectomy and axillary clearance (4 bilateral). Patients were divided into three groups. Group 1 no drain, Group 2 one drain, Group 3 two drains. There was no significant difference between the 3 groups in rate of seroma formation. Total volume of seroma and out patient aspirations were significantly higher in group 1 compared with group 3 (P=0.008 and P=0.03 respectively) however there was no significant difference between group 2 and 3. There was no significant difference in complication rates in the three groups. There was a significant reduction in hospital stay in groups 1 and 2 compared to group 3 (P=0.014). Conclusion: Drains did not prevent seroma formation, and were associated with a longer postoperative stay. There was no benefit in insertion of a second drain in reducing seroma volume and number of aspirations required. Second drain leads to a significantly longer hospital stay. The routine use of suction drains post mastectomy may not be warranted. Insertion of two drains is not justified. Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 4153.

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