Efficacy and safety of methylprednisolone in the prevention of seroma formation after mastectomy: Systematic review and meta-analysis

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BACKGROUND: Seroma, a common post-mastectomy complication linked to surgical inflammation, may be mitigated by anti-inflammatory agents such as methylprednisolone. METHODS: This meta-analysis evaluates methylprednisolone's efficacy and safety in preventing seroma. We systematically searched PubMed, Web of Science, Embase, Cochrane Library, China National Knowledge Infrastructure, and other Chinese databases for randomized controlled trials (RCTs) (from inception to March 2025) involving methylprednisolone use post-mastectomy. Two reviewers independently screened studies, extracted data, and assessed bias using ROB 2.0 and GRADE. Outcomes included seroma incidence, drainage metrics, wound complications, and seroma grading. Data were analyzed via Review Manager and Trial Sequential Analysis. RESULTS: The analysis included 7 randomized controlled trials with 589 patients, among whom 294 were administered methylprednisolone. The study found that the incidence of seroma (risk ratios = 0.73, 95% confidence interval [CI] 0.54-0.98, P = .04), total drainage volume (mean difference = -184.19, 95% CI: -215.30 to -153.09, P < .00001), and duration of drainage (mean difference = -3.37, 95% CI: -3.98, to -2.75, P < .00001) were significantly lower in the methylprednisolone group compared to the control group. Remarkably, this effect didn't extend to the incidence of wound complications (risk ratios = 0.93, 95% CI: 0.50-1.73, P = .82), nor did it influence seroma grading. The Trial Sequential Analysis results indicated that the evidence was sufficient and conclusive regarding the incidence of seroma, total drainage volume, and duration of drainage. CONCLUSION: Methylprednisolone may reduce the risk of seroma formation in patients undergoing mastectomy, along with reducing the total volume and duration of drainage. Further well-designed randomized controlled trials are needed to assess the impact of methylprednisolone on postoperative wound complications and seroma grading.

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