Does Axillary Tucking During Modified Radical Mastectomy Reduce Seroma Formation? - a Randomised Control Trial in 100 Patients

Aims: Seroma formation following modified radical mastectomy continues to be a major concern. The reported incidence of seroma formation varies widely between 3% and 85%. Surgical techniques for obliteration of dead space following surgery have been shown to reduce the incidence and severity of seroma. Wide variation exists in the surgical techniques practiced by surgeons. The optimal methods to reduce seroma are still undefined. (1) Whether axillary tucking during modified radical mastectomy helps to reduce seroma formation and aspiration. (2) To evaluate factors affecting drain amount and seroma formation. Methods: 100 consecutive breast cancer patients planned for primary modified radical mastectomy were randomised into axillary tucking and no tucking groups. The total drain volume, date of drain removal, seroma formation and aspiration data were collected from hospital electronic records and patient drain charts. Statistical analysis was done using Chi square and T test methods. Results: The mean drain volumes were 700 and 776 ml for tucking and no tucking groups, respectively. A significantly greater proportion of patients in the tucking group had drainvolume P<500ml (P =0.017). The meannumber of drain days were 10.16 and 11.8 days, respectively, for tucking and no tucking groups and the difference was significant (P =0.005). No significant difference was found in the number of seroma aspirations between the two groups (P =0.42). Age, diabetes, hypertension, surgeon experience, surgical time, intraoperative blood loss, number of lymph nodes removed, number of positive nodes, lymphovascular invasion and perineural invasion had no significant association with drain volume or number of aspirations. Higher BMI and level III nodal dissection was significantly associated with more drain volume. Conclusions: Obliterating dead space by axillary tucking decreases total drain volume and causes early removal of drain. However, the number of aspirations for seroma was not significantly altered.