Closure of dead space after modified radical mastectomy: Does it reduce the incidence of seroma?

Breast cancer is the commonest cancer among females and considered as one of the leading causes of cancer deaths. Modified radical mastectomy (MRM) is the commonest procedure to be done for treatment of breast cancer in developing countries due to late diagnosis, and lack of screening programs. The aim of this study is to assess the importance of dead space closure technique after modified radical mastectomy as regards to; incidence of postoperative seroma, frequency of aspiration, and patient complications. Methods and patients: This study was conducted on 40 female patients admitted to the Surgical Oncology Unit, Alexandria Main University Hospital, and were indicated to MRM during a period from April 2014 to December 2015. The patients were randomly divided into two equal groups; group A (20 patients had MRM with the closure of dead space by suturing the skin flaps to the underlying muscles (quilting), and group B (20 patients had MRM with the closure of wound by the conventional method without closure of dead space. Results: Group (A) showed a significant reduction over the control group as regards to the daily drain output in the initial three postoperative days, the total amount of drained fluid and the drainage period (p=0.009, <0.001, <0.001 respectively), clinically significant seroma was observed in 22 of all patients. Group (A) showed a significant reduction in both rate and duration of seroma formation following drain removal compared to the control group. In cases of patients that develop se roma; the mean number of aspirations and the mean fluid volume aspirated were also decreased significantly in the group (A) compared to the control group. Conclusion: It was found that closure of dead space significantly reduces the total amount of drained fluid leading to early drain removal, total volume of seroma aspirated, and post-operative wound complications had been decreased.