Seroma formation in half v/s full vacuum suction drainage after modified radical mastectomy-a hospital based prospective cohort study

Background: Breast cancer is the second most common malignancy in Indian women. Surgery is the mainstay of treatment. Modified radical mastectomy with or without reconstruction or breast preservation in addition to axillary lymph node dissection are common surgical procedures in breast cancer. Surgery of the axilla is associated with numerous complications, including infection, lymphedema of the ipsilateral upper extremity and collection of fluid in surgical site (seroma). Most common complication after breast cancer surgery is seroma. The exact etiology of seroma formation remains controversial. It is an accepted fact that negative suction prevents seroma collection and helps in the adherence of the walls of the axilla thus reducing the dead space and allowing the lymphatics to close. But, High negative suction pressure generated by the drain can maintain lymph drainage by a negative pressure gradient, paradoxically, not allowing the lymphatic channels to close leading to continuous drainage and a higher incidence of seroma formation. In our study, we evaluated two groups of patients, who had, the full and half vacuum suction pressure drains in situ, respectively, for their effect on seroma formation. Methods- The study was conducted in the general surgery / Oncosurgery department of S.M.S. Medical College and attached group of hospitals, Jaipur, from March 2018 to Dec 2019. 40 patients each belonged to the two respective groups that were compared and evaluated for the seroma formation. Results: In the present study it was observed that high suction caused prolonged drainage, which can possibly be explained by the hypothesis that high negative suction may not allow, leaking lymphatics to close. Therefore no suction or high suction drainage both may contributed to the same result that is higher incidence of seroma formation and longer hospital stay. Discussion: To strike a balance between not having suction at all and having a very high or full negative suction, half negative suction drainage was used in the present study to achieve a shorter hospital stay without any increase in the rate of post-operative seroma formation. But it was not found to effectively reduce the Hospital stay and also did not increase the postoperative morbidity as compared to high (full) negative suction group.