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Spiekerman van Weezelenburg MA, de Rooij L, Aldenhoven L, van Kuijk SMJ, van Haaren ERM, Janssen A, Vissers YLJ, Beets GL, van Bastelaar J. Drain-free mastectomy and flap fixation: The interim analysis of a randomized controlled noninferiority trial. J Surg Oncol 2024; 129:975-980. [PMID: 38173366 DOI: 10.1002/jso.27577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 12/13/2023] [Indexed: 01/05/2024]
Abstract
INTRODUCTION Flap fixation after mastectomy has proven to be one of the most promising solutions to reduce seroma formation. Drain placement remains standard practice in many clinics, even though this may be redundant after flap fixation. METHODS This is a prospective randomized controlled trial comparing mastectomy and wound closure using flap fixation with or without drain placement. The primary outcome measure was clinically significant seroma (CSS) incidence. The aim of this interim analysis was to assess the assumptions for the sample size calculation and to provide preliminary results. RESULTS Between July 2020 and January 2023, 112 patients were included. CSS incidence was 9.1% in the drain group and 21% in the no-drain group. In total, 10 patients were lost to follow-up. These numbers are similar to the ones used for the sample size calculation. In the drain group, three patients required interventions for wound complications compared to nine in the no-drain group (odds ratio: 3.612 [95% confidence interval: 0.898-14.537]). CONCLUSION The sample size calculation seems to be correct and no protocol amendments are necessary. Current preliminary results show no significant differences in CSS incidence. Complete results should be awaited to draw a well-powered conclusion regarding drain policy after mastectomy.
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Affiliation(s)
| | - Lisa de Rooij
- Department of Surgery, Zuyderland Medical Centre, Sittard, Limburg, the Netherlands
| | - Loeki Aldenhoven
- Department of Surgery, Zuyderland Medical Centre, Sittard, Limburg, the Netherlands
| | - Sander M J van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, the Netherlands
| | | | - Alfred Janssen
- Department of Surgery, Zuyderland Medical Centre, Sittard, Limburg, the Netherlands
| | - Yvonne L J Vissers
- Department of Surgery, Zuyderland Medical Centre, Sittard, Limburg, the Netherlands
| | - Geerard L Beets
- Department of Surgery, Netherlands Cancer Institute, Amsterdam, the Netherlands
- GROW School for Oncology and Developmental Biology, University of Maastricht, Maastricht, the Netherlands
| | - James van Bastelaar
- Department of Surgery, Zuyderland Medical Centre, Sittard, Limburg, the Netherlands
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2
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Fairhurst K, Roberts K, Fairbrother P, Potter S. Current use of drains and management of seroma following mastectomy and axillary surgery: results of a United Kingdom national practice survey. Breast Cancer Res Treat 2024; 203:187-196. [PMID: 37878150 PMCID: PMC10787912 DOI: 10.1007/s10549-023-07042-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 07/06/2023] [Indexed: 10/26/2023]
Abstract
PURPOSE Up to 40% of the 56,000 women diagnosed with breast cancer each year in the UK undergo mastectomy. Seroma formation following surgery is common, may delay wound healing, and be uncomfortable or delay the start of adjuvant treatment. Multiple strategies to reduce seroma formation include surgical drains, flap fixation and external compression exist but evidence to support best practice is lacking. We aimed to survey UK breast surgeons to determine current practice to inform the feasibility of undertaking a future trial. METHODS An online survey was developed and circulated to UK breast surgeons via professional and trainee associations and social media to explore current attitudes to drain use and management of post-operative seroma. Simple descriptive statistics were used to summarise the results. RESULTS The majority of surgeons (82/97, 85%) reported using drains either routinely (38, 39%) or in certain circumstances (44, 45%). Other methods for reducing seroma such as flap fixation were less commonly used. Wide variation was reported in the assessment and management of post-operative seromas. Over half (47/91, 52%) of respondents felt there was some uncertainty about drain use after mastectomy and axillary surgery and two-thirds (59/91, 65%) felt that a trial evaluating the use of drains vs no drains after simple breast cancer surgery was needed. CONCLUSIONS There is a need for a large-scale UK-based RCT to determine if, when and in whom drains are necessary following mastectomy and axillary surgery. This work will inform the design and conduct of a future trial.
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Affiliation(s)
- K Fairhurst
- Centre for Surgical Research, Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England.
| | - K Roberts
- Bristol Trials Centre, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England
| | - P Fairbrother
- Independent Cancer Patient Voice (ICPV), London, England
| | - S Potter
- Centre for Surgical Research, Department of Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, England
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3
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Ballance L, Wilson RL, Kirwan CC, Boundouki G, Taxiarchi VP, Baker BG, Rusius V, Rowland M, Henderson JR, Marikakis N, McAleer J, Harvey JR, Northwest Breast Research Collaborative OBOT. Return to Activities of Daily Living after Breast Cancer Surgery: An Observational Prospective Questionnaire-Based Study of Patients Undergoing Mastectomy with or without Immediate Reconstruction. Breast J 2023; 2023:9345780. [PMID: 37771428 PMCID: PMC10533274 DOI: 10.1155/2023/9345780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 08/10/2023] [Accepted: 08/22/2023] [Indexed: 09/30/2023]
Abstract
Background Patients often ask about the time taken to return to activities of daily living (ADLs) after breast surgery, but there is a lack of data to give accurate guidance. We aimed to assess the feasibility of a study to determine the time taken to return to ADLs after mastectomy with or without breast reconstruction. Materials and Methods A prospective multicentre, self-reported questionnaire-based feasibility study of women who had undergone mastectomy ± reconstruction was performed, between Jan 2017 and Dec 2019. Women were asked to self-report when they returned to 15 ADLs with a 5-option time scale for "return to activity." Results The questionnaire was returned by 42 patients (median [range] age: 64 [31-84]). Of these, 22 had simple mastectomy, seven mastectomy and implant reconstruction, seven mastectomy and autologous reconstruction (DIEP), and six did not specify. Overall, over 90% could manage stairs and brush hair by two weeks and 84% could get in and out of the bath by four weeks. By 1-2 months, 92% could do their own shopping and 86% could drive. 68% of women employed returned to work within four months. Compared to simple mastectomy, patients undergoing reconstruction took a longer time to return to getting in/out of bath (<2 vs. 2-4 weeks), vacuuming (2-4 weeks vs. 1-2 months), and fitness (1-2 vs. 3-4 months). There was a slower return to shopping (1-2 months vs. 2-4 weeks), driving and work (both 3-4 vs. 1-2 months), and sports (3-4 vs. 1-2 months) in autologous reconstruction compared to implant reconstruction. Conclusion This study is feasible. It highlights slower return to specific activities (particularly strength-based) in reconstruction patients, slower in autologous compared with implant reconstruction. The impact on return to ADLs should be discussed as part of the preoperative counselling as it will inform patients and help guide their decision making. A larger study is required to confirm these results.
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Affiliation(s)
- L. Ballance
- The Nightingale Breast Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Southmoor Road, Manchester M23 9LT, UK
| | - R. L. Wilson
- The Nightingale Breast Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Southmoor Road, Manchester M23 9LT, UK
| | - C. C. Kirwan
- The Nightingale Breast Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Southmoor Road, Manchester M23 9LT, UK
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - G. Boundouki
- Sheffield Breast Unit, Royal Hallamshire Hospital, Sheffield S10 2JF, UK
| | - V. P. Taxiarchi
- The Nightingale Breast Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Southmoor Road, Manchester M23 9LT, UK
- Centre for Women's Mental Health, Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - B. G. Baker
- The Nightingale Breast Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Southmoor Road, Manchester M23 9LT, UK
| | - V. Rusius
- Burnley Breast Unit, Burnley General Hospital, East Lancashire Hospitals NHS Trust, Casterton Avenue, Burnley BB10 2PQ, UK
| | - M. Rowland
- Liverpool Breast Unit, Linda McCartney Centre, Royal Liverpool University Hospital, Prescot Street, Liverpool L7 8XP, UK
| | - J. R. Henderson
- Liverpool Breast Unit, Linda McCartney Centre, Royal Liverpool University Hospital, Prescot Street, Liverpool L7 8XP, UK
| | - N. Marikakis
- Queen Alexandra Hospital, Portsmouth Hospitals NHS Trust, Southwick Hill Road, Cosham, Portsmouth, Hampshire PO6 3LY, UK
| | - J. McAleer
- Breast Care Centre, Ainscoe House, Blackpool Victoria Hospital, 12 E Park Dr, Blackpool FY3 8DX, UK
| | - J. R. Harvey
- The Nightingale Breast Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Southmoor Road, Manchester M23 9LT, UK
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
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4
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Montemurro P, Gupta T. It Is Time to Resolve the Dilemma and Move Away From Using Drains in Primary Breast Augmentation. Aesthet Surg J Open Forum 2023; 5:ojad048. [PMID: 37457442 PMCID: PMC10339086 DOI: 10.1093/asjof/ojad048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023] Open
Abstract
Background Breast augmentation is one of the most commonly performed aesthetic surgical procedures, yet there has been no consensus on the use of drains. While some surgeons believe in using them due to fear of complications or because they were taught in a conventional manner, the authors present their experience of performing breast surgery without the use of drains. Objectives To study whether performing breast augmentation without the use of drains is safe. Methods Anthropometric details and complications of all the consecutive primary breast augmentation patients performed by a single surgeon from 2009 to 2022 were collected and analyzed. In none of these patients, drains were used. Results A total of 429 (21%) patients were lost to follow-up and only those 1617 patients with a minimum follow-up of 6 months were included in this study. The mean age of the study group was 29.8 years with a mean BMI of 24.68. Mean follow-up was 16.24 months. Hematoma occurred in 15 patients (0.92%), seroma in 12 (0.74%), explantation due to infection in 3 patients (0.18%), and capsular contracture in 44 patients (2.72%). All these complications were in the lower range of complications of breast augmentation reported in the literature. Conclusions Unwarranted use of drains in breast augmentation should be avoided as it does not seemingly prevent the complications of breast augmentation surgery. Instead, it may increase the chances of infection, pain, and discomfort, and prolong the antibiotic coverage, and hence put an additional overall financial burden on the patient. Level of Evidence 4
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Affiliation(s)
- Paolo Montemurro
- Corresponding Author: Dr Paolo Montemurro, Storängsvägen 10, 11452 Stockholm, Sweden. E-mail: ; Instagram: @paolomontemurro; Twitter: @p_montemurro
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5
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Pintault C, Pondaven A, Lebechec A, Jugan AL, Coudriou C, Berti MDE, Ouldamer L. Implementation of Enhanced Recovery After Surgery Pathway for Patients Undergoing Mastectomy. J Gynecol Obstet Hum Reprod 2023; 52:102600. [PMID: 37150481 DOI: 10.1016/j.jogoh.2023.102600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Revised: 05/01/2023] [Accepted: 05/04/2023] [Indexed: 05/09/2023]
Abstract
BACKGROUND - Mastectomy is still a common treatment for breast cancer. The introduction of the Enhanced Recovery After Surgery pathway (ERAS) having proven its benefits for major surgeries has not yet been validated for mastectomy without reconstruction. Our study was conducted to investigate the effects of implementing an ERAS pathway for mastectomies, including the length of hospital stay, postoperative complications and patient satisfaction. METHOD -The study population included all patients who underwent mastectomy without immediate breast reconstruction in the gynecological surgery department of the Tours University Hospital during the year 2020. We compared patients who underwent an ERAS protocol with those who were managed in a standard manner. RESULTS - Of the 92 patients managed for mastectomy, 32 were managed in the ERAS group. The two groups were comparable. We found fewer postoperative complications with this protocol in multivariate analysis. We also obtained a 37% response rate to the satisfaction questionnaires. We did not find any significant difference between the 2 groups. CONCLUSION - There is a trend towards a decrease in the length of hospitalization associated with a decrease in postoperative complications thanks to the implementation of a ERAS protocol for the management of mastectomies. Future studies should focus on both objective clinical outcomes and patient-reported experiences to provide a comprehensive understanding of the effectiveness of ERAS protocols in mastectomy patients.
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Affiliation(s)
- C Pintault
- Department of Gynaecology, Centre Hospitalier Régional Universitaire de Tours, Hôpital Bretonneau, 2 boulevard Tonnellé, 37044 Tours, France; François-Rabelais University, 10 boulevard Tonnelé, BP 3223, 37032 Tours cedex, France
| | - A Pondaven
- Department of Gynaecology, Centre Hospitalier Régional Universitaire de Tours, Hôpital Bretonneau, 2 boulevard Tonnellé, 37044 Tours, France; François-Rabelais University, 10 boulevard Tonnelé, BP 3223, 37032 Tours cedex, France
| | - A Lebechec
- Department of Gynaecology, Centre Hospitalier Régional Universitaire de Tours, Hôpital Bretonneau, 2 boulevard Tonnellé, 37044 Tours, France
| | - A L Jugan
- Department of Gynaecology, Centre Hospitalier Régional Universitaire de Tours, Hôpital Bretonneau, 2 boulevard Tonnellé, 37044 Tours, France
| | - C Coudriou
- Department of Anesthesiology, Centre Hospitalier Régional Universitaire de Tours, Hôpital Bretonneau, 2 boulevard Tonnellé, 37044 Tours, France
| | - M DE Berti
- Department of Gynaecology, Centre Hospitalier Régional Universitaire de Tours, Hôpital Bretonneau, 2 boulevard Tonnellé, 37044 Tours, France; François-Rabelais University, 10 boulevard Tonnelé, BP 3223, 37032 Tours cedex, France
| | - L Ouldamer
- Department of Gynaecology, Centre Hospitalier Régional Universitaire de Tours, Hôpital Bretonneau, 2 boulevard Tonnellé, 37044 Tours, France; François-Rabelais University, 10 boulevard Tonnelé, BP 3223, 37032 Tours cedex, France; INSERM unit 1069, Tours, France.
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6
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Nadia S, Rivai F, Sidin I, Pasinringi SA. What is known about patient-centered care application in post-surgical breast cancer patients? Breast Dis 2023; 42:233-243. [PMID: 37522192 DOI: 10.3233/bd-239004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
Abstract
BACKGROUND Over the past two decades, patient-centered care has become internationally recognized as a dimension of high-quality health care. Recent research has shown that patient-centered care has many benefits, which are broadly categorized as patient experience and clinical and operational benefits. OBJECTIVE The study aimed at analyzing the correlation between the application of patient-centered care (PCC) and length of stay, patient satisfaction, and clinical outcome of post-surgical breast cancer patients. METHODS The study design was cross-sectional. A sample of 100 patients was determined and selected with the inclusion criteria. Data were collected using measuring tools comprising patient-centered care and patient satisfaction questionnaires as well as medical records to evaluate the length of stay and clinical outcomes. Bivariate analysis was conducted to analyze the correlation between patient-centered-care and length of stay (LOS), patient satisfaction, and the clinical outcomes of inpatients. RESULTS A correlation was found between patient-centered care (PCC) application and patient satisfaction (p = 0.005), but no correlation was observed between PCC application and length of stay (LOS) (p = 0.176) as well as clinical outcome (p = 0.128). CONCLUSIONS The application of patient-centered care can be attributed to patient satisfaction but is not correlated to length of stay and clinical outcome of post-surgical breast cancer patients. The hospital should create an accepted definition and commonly agreed set of dimensions used for the concept of operationalization and its measurement to implement PCC and improve overall patient satisfaction and clinical outcome and reduce the length of stay as expected.
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Affiliation(s)
- Shafa Nadia
- Faculty of Public Health, Hasanuddin University, Makassar, Indonesia
| | - Fridawaty Rivai
- Faculty of Public Health, Hasanuddin University, Makassar, Indonesia
- Hasanuddin University Hospital, Makassar, South Sulawesi, Indonesia
| | - Indahwaty Sidin
- Faculty of Public Health, Hasanuddin University, Makassar, Indonesia
- Hasanuddin University Hospital, Makassar, South Sulawesi, Indonesia
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7
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A comparative study of Drain in Oncoplastic Breast Conserving Surgery (therapeutic mammaplasty and chest wall perforator flap partial breast reconstruction) versus mastectomy. Clin Breast Cancer 2022; 22:619-627. [DOI: 10.1016/j.clbc.2022.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 05/02/2022] [Accepted: 05/04/2022] [Indexed: 01/17/2023]
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8
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Rao D, Xie J, Xia Y, Cao D. Comparison of Flap Fixation to Its Bed and Conventional Wound Closure with Drainage in Preventing Seroma Formation Following Mastectomy for Breast Cancer: Systematic Review and Meta-analysis. Aesthetic Plast Surg 2022; 46:1180-1188. [PMID: 35226117 DOI: 10.1007/s00266-022-02814-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 01/27/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Seroma formation is a common complication following mastectomy. The objective of this systematic review and meta-analysis is to evaluate the impact of flap fixation techniques that omit drainage versus conventional closed drainage on seroma formation and related complications after mastectomy. METHODS Clinical studies of flap fixation techniques versus the conventional closure technique in patients undergoing mastectomy with or without axillary clearance were retrieved from the PubMed, Embase and Cochrane databases. Papers were eligible for inclusion if the outcome was described in terms of seroma formation. Studies older than 20 years, animal studies and studies involving patients undergoing direct breast reconstruction were excluded. RESULTS Four randomized controlled trials (RCTs) and four cohort studies were included in our examination. Compared with the conventional drainage group, the flap fixation group had a similar incidence of seroma formation (OR 0.76, 95% CI 0.30-1.93, p = 0.57). CONCLUSION Based on current evidence, mechanical flap fixation can replace conventional drainage without increasing seroma formation after mastectomy. Further well-designed RCTs are warranted to evaluate the effects of flap fixation. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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9
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The Use of Hemostatic Agents to Decrease Bleeding Complications in General Plastic Surgery Procedures. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3744. [PMID: 34667700 PMCID: PMC8517290 DOI: 10.1097/gox.0000000000003744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 06/14/2021] [Indexed: 11/26/2022]
Abstract
Within plastic surgery, hematomas and seromas are frequently reported complications that can negatively impact wound healing and result in significant morbidity in patients. As a result, there has been considerable interest in hemostatic agents to complement traditional methods of hemostasis. The purpose of this study was to evaluate postoperative bleeding complications and duration of Jackson-Pratt (JP) drain use in general plastic surgery procedures with and without hemostatic agents.
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10
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Timmermans FW, Mokken SE, Smit JM, Zwanenburg PR, van Hout N, Bouman MB, Middelkoop E, Mullender MG. Within-patient randomized clinical trial comparing incisional negative-pressure wound therapy with suction drains in gender-affirming mastectomies. Br J Surg 2021; 108:925-933. [PMID: 34244715 PMCID: PMC10364878 DOI: 10.1093/bjs/znab204] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 05/06/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Incisional negative-pressure wound therapy (iNPWT) is widely adopted by different disciplines for multiple indications. Questions about the most appropriate uses and value of iNPWT have been raised. METHODS An open-label within-patient RCT was conducted in transgender men undergoing gender-affirming mastectomies. The objective was to determine the effect of iNPWT as a substitute for standard dressing and suction drains on wound healing complications. One chest side was randomized to receive the iNPWT intervention, and the other to standard dressing with suction drain. The primary endpoints were wound healing complications (haematoma, seroma, infection, and dehiscence) after three months. Additional outcomes were pain according to a numerical rating scale and patient satisfaction one week after surgery. RESULTS Eighty-five patients were included, of whom 81 received both the iNPWT and standard treatment. Drain removal criteria were met within 24 h in 95 per cent of the patients. No significant decrease in wound healing complications was registered on the iNPWT side, but the seroma rate was significantly increased. In contrast, patients experienced both significantly less pain and increased comfort on the iNPWT side. No medical device-related adverse events were registered. CONCLUSION Substituting short-term suction drains with iNPWT in gender-affirming mastectomies increased the seroma rates and did not decrease the amount of wound healing complications. Registration number: NTR7412 (Netherlands Trial Register).
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Affiliation(s)
- F W Timmermans
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands.,Centre of Expertise on Gender Dysphoria, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - S E Mokken
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands.,Centre of Expertise on Gender Dysphoria, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health, Amsterdam, the Netherlands
| | - J M Smit
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands.,Centre of Expertise on Gender Dysphoria, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Amsterdam Medical Centre, Amsterdam, the Netherlands
| | - P R Zwanenburg
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands.,Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Amsterdam Medical Centre, Amsterdam, the Netherlands
| | - N van Hout
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands.,Centre of Expertise on Gender Dysphoria, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Amsterdam Medical Centre, Amsterdam, the Netherlands
| | - M B Bouman
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands.,Centre of Expertise on Gender Dysphoria, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health, Amsterdam, the Netherlands.,Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Amsterdam Medical Centre, Amsterdam, the Netherlands
| | - E Middelkoop
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands.,Association of Dutch Burn Centres, Red Cross Hospital, Beverwijk, the Netherlands
| | - M G Mullender
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands.,Centre of Expertise on Gender Dysphoria, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health, Amsterdam, the Netherlands.,Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Amsterdam Medical Centre, Amsterdam, the Netherlands
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11
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Lembo F, Cecchino LR, Parisi D, Portincasa A. Reduction of seroma and improvement of quality of life after early drain removal in immediate breast reconstruction with tissue expander. Preliminary report from a randomized controlled study. J Plast Reconstr Aesthet Surg 2021; 74:2565-2572. [PMID: 33781704 DOI: 10.1016/j.bjps.2021.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Revised: 01/07/2021] [Accepted: 02/26/2021] [Indexed: 12/31/2022]
Abstract
Seroma is the most common complication of breast reconstruction with tissue expander (incidence 0.2-20%) with increased risk of infection and implant loss by 4-6 fold. About 90% of plastic surgeons routinely placed drains for its prevention. We theorized that early drain removal is a safe procedure that improves postoperative quality of life (QoL), reducing pain, length of hospital stay, and limitations on daily activities. We divided 49 patients operated on between September 2016 and March 2018 (follow-up: 9-26 months) into two groups: Group1 (output-based; drains removed when <30 ml/day); and Group2 (early-removal; at 3-4 days postop.). A study-specific questionnaire about the patient's QoL was conducted 3 weeks after surgery. We performed an intention-to-treat analysis. A comparison was performed using a Fisher test and a Mann-Whitney U test with p = 0.05. We observed lower production of wound fluid (641±49 ml vs 231±20 ml; p = 0.004), and a shorter time until wound healing (31.3±4.2 days vs 22±3.9 days; p = 0.031) for Group 2. The difference for infection (p = 0.36), impaired wound healing (p = 0.22), and the seroma formation period (p = 0.11) was not significant. Group 2 experienced less breast pain (8% vs 87.5%; p = 0.001), fewer limitations in daily activities (16% vs 50%; p = 0.002), in mobility (20% vs 83.3%; p = 0.001), and in social life (8% vs 91.7%; p < 0.001), and a better quality of sleep than Group 1 (36% vs 75%; p = 0.002). Group 2 did not require home care after hospital discharge (p < 0.001). The limitations of study are: its small sample size, the wound healing assessment, and the use of a non-validated questionnaire.
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Affiliation(s)
- Fedele Lembo
- Department of Plastic and Reconstructive Surgery - OspedaliRiuniti-University of Foggia, Viale Pinto,1 - Foggia, Italy.
| | - Liberato Roberto Cecchino
- Department of Plastic and Reconstructive Surgery - OspedaliRiuniti-University of Foggia, Viale Pinto,1 - Foggia, Italy
| | - Domenico Parisi
- Department of Plastic and Reconstructive Surgery - OspedaliRiuniti-University of Foggia, Viale Pinto,1 - Foggia, Italy
| | - Aurelio Portincasa
- Department of Plastic and Reconstructive Surgery - OspedaliRiuniti-University of Foggia, Viale Pinto,1 - Foggia, Italy
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12
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De Rooij L, Bosmans JWAM, van Kuijk SMJ, Vissers YLJ, Beets GL, van Bastelaar J. A systematic review of seroma formation following drain-free mastectomy. Eur J Surg Oncol 2020; 47:757-763. [PMID: 33051116 DOI: 10.1016/j.ejso.2020.10.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 09/14/2020] [Accepted: 10/09/2020] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Seroma is a common complication after mastectomy. The aim of this review is to elucidate whether closed suction drainage can safely be omitted in patients undergoing mastectomy when assessing seroma formation and its complications. The second aim is to assess the influence of flap fixation on seroma related complications, as there is existing evidence showing that combining mastectomy with flap fixation may make the use of drainage systems obsolete. SEARCH & SELECTION A review of the literature was performed and articles that compared mastectomy with drainage and mastectomy without drainage were selected. Due to the small number of eligible studies, no selection based on whether flap fixation was performed was possible. If outcome was described in terms of seroma formation or seroma related complications, papers were eligible for inclusion. Studies older than 20 years, animal studies, studies not written in English and studies with male patients were excluded. RESULTS A total of eight articles were eligible for inclusion. Four prospective studies and four retrospective studies were included. In four studies, flap fixation was performed. Frequency of seroma formation as well as seroma that required intervention was reported. The included studies demonstrated that omitting closed suction drainage does not lead to a higher incidence of seroma formation in patients undergoing mastectomy. CONCLUSION Despite substantial heterogeneity, there is evidence that drainage can safely be omitted without exacerbating seroma formation and its complications. A well-powered, randomized controlled trial evaluating the effect of drainage omission on seroma formation, with or without flap fixation, is needed.
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Affiliation(s)
- L De Rooij
- Department of Surgery, Zuyderland Medical Center, Sittard, the Netherlands.
| | - J W A M Bosmans
- Department of Surgery, Zuyderland Medical Center, Sittard, the Netherlands
| | - S M J van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Y L J Vissers
- Department of Surgery, Zuyderland Medical Center, Sittard, the Netherlands
| | - G L Beets
- Department of Surgery, Netherlands Cancer Institute, Amsterdam, the Netherlands; GROW School for Oncology and Developmental Biology, University of Maastricht, Maastricht, the Netherlands
| | - J van Bastelaar
- Department of Surgery, Zuyderland Medical Center, Sittard, the Netherlands
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de Rooij L, van Kuijk SMJ, van Haaren ERM, Janssen A, Vissers YLJ, Beets GL, van Bastelaar J. A single-center, randomized, non-inferiority study evaluating seroma formation after mastectomy combined with flap fixation with or without suction drainage: protocol for the Seroma reduction and drAin fRee mAstectomy (SARA) trial. BMC Cancer 2020; 20:735. [PMID: 32767988 PMCID: PMC7412663 DOI: 10.1186/s12885-020-07242-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 07/30/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Seroma formation is a common complication after breast cancer surgery and can lead to delayed wound healing, infection, patient discomfort and repeated visits to the outpatient clinic. Mastectomy combined with flap fixation is becoming standard practice and is currently combined with closed-suction drainage. There is evidence showing that closed-suction drainage may be insufficient in preventing seroma formation. There is reasonable doubt whether there is still place for closed-suction drainage after mastectomy when flap fixation is performed. We hypothesize that mastectomy combined with flap fixation and closed suction drainage does not cause a significant lower incidence of seroma aspirations, when compared to mastectomy and flap fixation alone. Furthermore, we expect that patients without drainage will experience significantly less discomfort and comparable rates of surgical site infections. METHODS This is a randomized controlled trial in female breast cancer patients undergoing mastectomy and flap fixation using sutures with or without sentinel lymph node biopsy (SLNB). Patients will be eligible for inclusion if they are older than 18 years, have an indication for mastectomy with or without sentinel procedure. Exclusion criteria are modified radical mastectomy, direct breast reconstruction, previous history of radiation therapy of the unilateral breast, breast conserving therapy and inability to give informed consent. A total of 250 patients will be randomly allocated to one of two groups: mastectomy combined with flap fixation and closed-suction drainage or mastectomy combined with flap fixation without drainage. Follow-up will be conducted up to six months postoperatively. The primary outcome is the proportion of patients undergoing one or more seroma aspirations. Secondary outcome measures consist of the number of invasive interventions, surgical site infection, quality of life measured using the SF-12 Health Survey, cosmesis, pain and number of additional outpatient department visits. DISCUSSION To our knowledge, no randomized controlled trial has been conducted comparing flap fixation with and without closed-suction drainage with seroma aspiration as the primary outcome. This study could result in finding evidence that supports performing mastectomy without closed-suction drainage. TRIAL REGISTRATION This trial was approved by the medical ethical committee of Zuyderland Medical Center METC-Z on 20 March 2019 (METCZ20190023). The SARA Trial was registered at ClinicalTrials.gov as per July 2019, Identifier: NCT04035590 .
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Affiliation(s)
- Lisa de Rooij
- Department of Surgery, Zuyderland Medical Center, Postbus 5500, 6130, MB, Sittard, the Netherlands.
| | - Sander M J van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Els R M van Haaren
- Department of Surgery, Zuyderland Medical Center, Postbus 5500, 6130, MB, Sittard, the Netherlands
| | - Alfred Janssen
- Department of Surgery, Zuyderland Medical Center, Postbus 5500, 6130, MB, Sittard, the Netherlands
| | - Yvonne L J Vissers
- Department of Surgery, Zuyderland Medical Center, Postbus 5500, 6130, MB, Sittard, the Netherlands
| | - Geerard L Beets
- Department of Surgery, Netherlands Cancer Institute, Amsterdam, the Netherlands
- GROW School for Oncology and Developmental Biology, University of Maastricht, Maastricht, the Netherlands
| | - James van Bastelaar
- Department of Surgery, Zuyderland Medical Center, Postbus 5500, 6130, MB, Sittard, the Netherlands
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Xiao Y, Hu J, Zhang M, Zhang W, Qin F, Zeng A, Wang X, Liu Z, Zhu L, Yu N, Si L, Long F, Ding Y. To use indwelling drainage or not in dual-plane breast augmentation mammoplasty patients: A comparative study. Medicine (Baltimore) 2020; 99:e21305. [PMID: 32702925 PMCID: PMC7373562 DOI: 10.1097/md.0000000000021305] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
To explore the necessity of indwelling drainage in dual-plane breast augmentation mammoplasty patients.Female patients (123 in total) were selected from June 2015 to June 2018 in the Department of Plastic Surgery at Peking Union Medical College Hospital and were randomly divided into 2 different groups: the with drainage group (WD group, 57 patients) and the without drainage group (WOD group, 66 patients). In the 2 groups, the operation time, postoperative stay, and hospitalization expenses were recorded. The BREAST-Q Version 2.0 Augmentation Module Pre- and Postoperative Scales (Chinese Version) were used to evaluate psychosocial well-being, sexual well-being, physical well-being, and satisfaction with breasts preoperatively and postoperatively (1 year after operation).Before the operation, no significant differences were found in psychosocial well-being, sexual well-being, physical well-being, or satisfaction with breasts between these 2 groups. In the WOD group, postoperative stay and hospitalization expenses were remarkably decreased, but the operation time was similar, compared with the WD group. Compared with before the operation, both groups had significantly increased scores in psychosocial well-being, sexual well-being, and satisfaction with breasts after the operation. However, no significant differences were found between the 2 groups. No complications were found in any of the patients.Although the operation time was not significantly decreased, patients without drainage could save much more time and money and simultaneously reach similar postoperative effects in psychosocial well-being, sexual well-being, physical well-being, and satisfaction with breasts. Therefore, drainage may not be necessary in patients who undergo dual-plane breast augmentation mammoplasty.
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Affiliation(s)
- Yiding Xiao
- Department of Plastic Surgery, Peking Union Medical College Hospital, Beijing
| | - Jianqiang Hu
- Department of Orthopaedics, Qingdao Huangdao District Hospital of Traditional Chinese Medicine, Qingdao, Shandong
| | - Mingzi Zhang
- Department of Plastic Surgery, Peking Union Medical College Hospital, Beijing
| | - Wenchao Zhang
- Department of Plastic Surgery, Peking Union Medical College Hospital, Beijing
| | - Feng Qin
- Department of Plastic Surgery, Peking Union Medical College Hospital, Beijing
| | - Ang Zeng
- Department of Plastic Surgery, Peking Union Medical College Hospital, Beijing
| | - Xiaojun Wang
- Department of Plastic Surgery, Peking Union Medical College Hospital, Beijing
| | - Zhifei Liu
- Department of Plastic Surgery, Peking Union Medical College Hospital, Beijing
| | - Lin Zhu
- Department of Plastic Surgery, Peking Union Medical College Hospital, Beijing
| | - Nanze Yu
- Department of Plastic Surgery, Peking Union Medical College Hospital, Beijing
| | - Loubin Si
- Department of Plastic Surgery, Peking Union Medical College Hospital, Beijing
| | - Fei Long
- Department of Plastic Surgery, Peking Union Medical College Hospital, Beijing
| | - Yu Ding
- Department of Information Engineering, Chaoshan Polytechnic College, Puning, Guangdong, China
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Wu Y, Wang S, Hai J, Mao J, Dong X, Xiao Z. Quilting suture is better than conventional suture with drain in preventing seroma formation at pectoral area after mastectomy. BMC Surg 2020; 20:65. [PMID: 32252732 PMCID: PMC7137264 DOI: 10.1186/s12893-020-00725-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 03/24/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The aim of this study was to compare quilting suture with conventional suture on the formation of seroma at pectoral area after mastectomy (ME) with sentinel lymph nodes biopsy (SLN) or axillary lymph nodes dissection (ALND) for breast cancer. METHODS Two hundred thirty-five consecutive breast cancer patients were retrospectively analyzed. The primary outcome was the incidence of Grade 2 or Grade 3 seroma at anterior pectoral area within 1 month postoperatively. We categorized seroma into early or late seroma according to the drainage removal time. Cox regression was used for analysis. RESULTS The incidence of Grade 2 and 3 seroma was significantly higher in the conventional suture group compared with that in the quilting suture group (19.3% vs. 9.5%, p = 0.032), which was attributed to the late seroma in Grade 2 and 3. Quilting suture was associated with longer time for fixing flaps compared with that of conventional suture (504.7 s vs. 109.1 s, p < 0.001), but with less volume of drainage. Old age, high body mass index and conventional suture were independently risk factors for Grade 2 and 3 seroma. CONCLUSIONS Quilting suture decreased the incidence of Grade 2 and 3 seroma at pectoral area within 1 month after mastectomy, especially the late seroma in Grade 2 and 3.
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Affiliation(s)
- Yuhui Wu
- Department of Breast Surgery, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, P. R. China, 410008
| | - Shouman Wang
- Department of Breast Surgery, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, P. R. China, 410008
| | - Jian Hai
- Department of Breast Surgery, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, P. R. China, 410008
| | - Jie Mao
- Department of Breast Surgery, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, P. R. China, 410008
| | - Xue Dong
- Department of Breast Surgery, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, P. R. China, 410008
| | - Zhi Xiao
- Department of Breast Surgery, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, P. R. China, 410008. .,Clinical Research Center For Breast Cancer Control and Prevention In Human Province, Changsha, P. R. China.
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Pallara T, Fortunato L, Folli S, Roncella M, Scuderi N, Friedman D, Arnez Z, Ribuffo D, Manna E, Persichetti P. Practice patterns regarding drains management in breast surgery: Results of a survey of Senonetwork Italia breast centers. Breast J 2019; 26:560-562. [PMID: 31549473 DOI: 10.1111/tbj.13602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Revised: 06/22/2019] [Accepted: 06/24/2019] [Indexed: 11/30/2022]
Affiliation(s)
| | | | - Secondo Folli
- Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milano, Italy
| | | | - Nicolò Scuderi
- Università degli Studi di Roma "La Sapienza", Roma, Italy
| | - Daniele Friedman
- IRCCS Azienda Ospedaliera Universitaria San Martino - IST - Istituto Nazionale per la Ricerca sul Cancro, Genova, Italy
| | - Zoran Arnez
- Dipartimento delle Scienze Mediche, Chirurgiche e della Salute, ASUITS Azienda Sanitaria Universitaria Integrata di Trieste, Università degli Studi di Trieste, Trieste, Italy
| | - Diego Ribuffo
- Università degli Studi di Roma "La Sapienza", Roma, Italy
| | - Elena Manna
- Azienda Ospedaliera San Giovanni-Addolorata, Roma, Italy
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Jackson PC, MacInnes EG, Nicholson JK, Brayshaw I, Relton S, Achuthan R. Mastectomy Without Drains Reduces Cost with No Detriment to Patient Outcome. Cureus 2019; 11:e5160. [PMID: 31528512 PMCID: PMC6743667 DOI: 10.7759/cureus.5160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction Use of drains after mastectomy remains highly variable. This study aimed to establish whether simple mastectomy managed without a drain would cost less than the same procedure managed with a drain and whether there would be any difference in complications. Methods Prospective data were collected on all patients undergoing simple mastectomy ± sentinel lymph node biopsy over sixteen months. Surgeons decided intra-operatively whether to place a drain. Data included operative details, mastectomy weight, length of stay and postoperative complications. Costing data were identified by combining hospital finance costs for admission and follow-up appointments along with the cost of consumables. Results One hundred and thirty mastectomies were performed on 119 patients. There was a significant difference in mastectomy weight between drain group patients (n=80, median: 730g) and no drain group patients (n=50, median: 424g) (p=<0.001). The mean cost for drain group patients was £639.77 whilst for the no drain group was £365.46, indicating a potential unit saving of £21944.93 over sixteen months. Length of stay was shorter in the no drain group (range: 1-2 days) than the drain group (range: 1-4 days). The presence or absence of drains did not influence complication rates, with no change in seroma interventions (p=0.803). Conclusions Managing simple mastectomy patients without a drain resulted in no increase in complications or subsequent interventions for seroma. Significant cost savings to both the hospital and to the patient can be achieved by omitting drain use. Routine use of drains in patients undergoing simple mastectomy ± SNB may be unnecessary and costly.
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Affiliation(s)
| | | | | | - Ian Brayshaw
- Breast Surgery, Leeds Teaching Hospitals Trust, Leeds, GBR
| | - Samuel Relton
- Miscellaneous, Leeds Institute of Health Sciences, The University of Leeds, Leeds, GBR
| | - Raj Achuthan
- Breast Surgery, Leeds Teaching Hospitals Trust, Leeds, GBR
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ten Wolde B, Strobbe FFR, Schlooz-de Vries M, van den Wildenberg FJH, Keemers-Gels M, de Wilt JHW, Strobbe LJA. Omitting Postoperative Wound Drainage After Mastectomy With Skin-Flap Quilting. Ann Surg Oncol 2019; 26:2773-2778. [DOI: 10.1245/s10434-019-07411-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Indexed: 11/18/2022]
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19
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Suarez-Kelly LP, Pasley WH, Clayton EJ, Povoski SP, Carson WE, Rudolph R. Effect of topical microporous polysaccharide hemospheres on the duration and amount of fluid drainage following mastectomy: a prospective randomized clinical trial. BMC Cancer 2019; 19:99. [PMID: 30674296 PMCID: PMC6345065 DOI: 10.1186/s12885-019-5293-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 01/07/2019] [Indexed: 02/07/2023] Open
Abstract
Background Seroma formation is the most common complication after mastectomy and places patients at risk of associated morbidities. Microporous polysaccharide hemospheres (MPH) consists of hydrophilic, plant based, polysaccharide particles and is currently used as an absorbable hemostatic agent. An animal model evaluating MPH and seroma formation after mastectomy with axillary lymph node dissection showed a significant decrease in seroma volume. Study aim was to evaluate topical MPH on the risk of post-mastectomy seroma formation as measured by total drain output and total drain days. Methods Prospective randomized single-blinded clinical trial of patients undergoing mastectomy for the treatment of breast cancer. MPH was applied to the surgical site in the study group and no application in the control group. Results Fifty patients were enrolled; eight were excluded due to missing data. Forty-two patients were evaluated, control (n = 21) vs. MPH (n = 21). No difference was identified between the two groups regarding demographics, tumor stage, total drain days, total drain output, number of clinic visits, or complication rates. On a subset analysis, body mass index (BMI) greater than 30 was identified as an independent risk factor for high drain output. Post hoc analyses of MPH controlling for BMI also revealed no statistical difference. Conclusions Unlike the data presented in an animal model, no difference was demonstrated in the duration and quantity of serosanguinous drainage related to the use of MPH in patients undergoing mastectomy for the treatment of breast cancer. BMI greater than 30 was identified as an independent risk factor for high drain output and this risk was not affected by MPH use. NCT03647930, retrospectively registered 08/2018.
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Affiliation(s)
- Lorena P Suarez-Kelly
- Memorial University Medical Center, 4700 Waters Ave, Savannah, GA, 31404, USA. .,The Arthur G. James Comprehensive Cancer Center and Solove Research Institute, The Ohio State University, 424 Wiseman Hall, 410 W. 12th Ave, Columbus, OH, 43210, USA.
| | - W Hampton Pasley
- Memorial University Medical Center, 4700 Waters Ave, Savannah, GA, 31404, USA
| | - Eric J Clayton
- Memorial University Medical Center, 4700 Waters Ave, Savannah, GA, 31404, USA
| | - Stephen P Povoski
- The Arthur G. James Comprehensive Cancer Center and Solove Research Institute, The Ohio State University, 424 Wiseman Hall, 410 W. 12th Ave, Columbus, OH, 43210, USA
| | - William E Carson
- The Arthur G. James Comprehensive Cancer Center and Solove Research Institute, The Ohio State University, 424 Wiseman Hall, 410 W. 12th Ave, Columbus, OH, 43210, USA
| | - Ray Rudolph
- Memorial University Medical Center, 4700 Waters Ave, Savannah, GA, 31404, USA
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Ohlinger R, Gieron L, Rutkowski R, Kohlmann T, Zygmunt M, Unger J. The Use of TissuGlu® Surgical Adhesive for Mastectomy With or Without Lymphonodectomy. ACTA ACUST UNITED AC 2018; 32:625-631. [PMID: 29695569 DOI: 10.21873/invivo.11284] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 03/03/2018] [Accepted: 03/06/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND/AIM Using drains after breast surgery is a preventive, but invasive measure to reduce seroma formation. A polyurethane-based tissue adhesive (TissuGlu®) might facilitate drainage-free wound healing after mastectomy in a non-invasive manner. PATIENTS AND METHODS Retrospectively, data from 84 patients (42 receiving TissuGlu®, 42 receiving a drainage) who underwent mastectomy, were collected (90 days postoperative follow-up). Study endpoints were defined as the number of fluid-related postoperative clinical interventions, cumulative volume of postoperative wound fluid, duration of hospitalization and postoperative complications. RESULTS In the entirety of postoperative interventions, no significant difference could be demonstrated (p=0.298). The drainage arm showed significantly less seroma aspirations (p=0.024) and complications (p=0.012). A significantly reduced length of hospitalization (p<0.001) and less cumulative wound secretion volume (p<0.001) appeared in the TissuGlu® group. CONCLUSION The polyurethane-based tissue adhesive is a less invasive alternative to drain use in mastectomy.
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Affiliation(s)
- Ralf Ohlinger
- Clinic and Polyclinic for Obstetrics and Gynecology, University Medicine Greifswald, Greifswald, Germany
| | - Leonie Gieron
- Clinic and Polyclinic for Obstetrics and Gynecology, University Medicine Greifswald, Greifswald, Germany
| | - Rico Rutkowski
- Department of Oral and Maxillofacial Surgery/Plastic Surgery, University Medicine Greifswald, Greifswald, Germany
| | - Thomas Kohlmann
- Department of Community Medicine, University Greifswald, Greifswald, Germany
| | - Marek Zygmunt
- Clinic and Polyclinic for Obstetrics and Gynecology, University Medicine Greifswald, Greifswald, Germany
| | - Julia Unger
- Clinic and Polyclinic for Obstetrics and Gynecology, University Medicine Greifswald, Greifswald, Germany
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The Impact of Closed Incision Negative Pressure Therapy on Postoperative Breast Reconstruction Outcomes. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2018; 6:e1880. [PMID: 30324063 PMCID: PMC6181498 DOI: 10.1097/gox.0000000000001880] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 06/08/2018] [Indexed: 12/27/2022]
Abstract
Background Studies report that incision management with closed incision negative pressure therapy (ciNPT) may provide clinical benefits, including protecting surgical incisions, for postsurgical closed incisions (eg, orthopedic, sternotomy, and colorectal). This retrospective analysis compared postoperative outcomes in patients who received ciNPT versus standard of care (SOC) for incision management after breast reconstruction postmastectomy. Methods Patient demographics, chemotherapy exposure, surgical technique, ciNPT use, number of drains, time to drain removal, and 90-day postoperative complication rates were analyzed from records of 356 patients (ciNPT = 177, SOC = 179) with 665 closed breast incisions (ciNPT = 331, SOC = 334). Results Overall complication rate was 8.5% (28/331) in ciNPT group compared with 15.9% (53/334) in SOC group (P = 0.0092). Compared with the SOC group, the ciNPT group had significantly lower infection rates [7/331 (2.1%) versus 15/334 (4.5%), respectively; P = 0.0225], dehiscence rates [8/331 (2.4%) versus 18/334 (5.4%), respectively; P = 0.0178], necrosis rates [17/331 (5.1%) versus 31/334 (9.3%), respectively; P = 0.0070], and seroma rates [6/331 (1.8%) versus 19/334 (5.7%), respectively; P = 0.0106]. The ciNPT group required significantly fewer returns to operating room compared with the SOC group [8/331 (2.4%) versus 18/334 (5.4%), respectively; P = 0.0496]. Time to complete drain removal per breast for ciNPT versus SOC groups was 9.9 versus 13.1 days (P < 0.0001), respectively. Conclusions Patients who received ciNPT over closed incisions following postmastectomy breast reconstruction experienced a shorter time to drain removal and significantly lower rates of infection, dehiscence, necrosis, and seromas, compared with the SOC group. Randomized controlled studies are needed to corroborate the findings in our study.
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Stoyanov GS, Tsocheva D, Marinova K, Dobrev E, Nenkov R. Drainage after Modified Radical Mastectomy - A Methodological Mini-Review. Cureus 2017; 9:e1454. [PMID: 28929038 PMCID: PMC5590707 DOI: 10.7759/cureus.1454] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Breast cancer is a socially relevant group of malignant conditions of the mammary gland, affecting both males and females. Most commonly the surgical approach of choice is a modified radical mastectomy (MRM), due to it allowing for both the removal of the main tumor mass and adjacent glandular tissue, which are suspected of infiltration and multifocality of the process, and a sentinel axillary lymph node removal. Most common post-surgical complications following MRM are the formation of a hematoma, the infection of the surgical wound and the formation of a seroma. These post-surgical complications can, at least in part, be attributed to the drainage of the surgical wound. However, the lack of modern and official guidelines provides an ample scope for innovation, but also leads to a need for a randomized comparison of the results. We compared different approaches to wound drainage after MRM, reviewed based on the armamentarium, number of drains, location, type of drainage system, timing of drain removal and no drainage alternatives. Currently, based on the general results, scientific and comparative discussions, seemingly the most affordable methodology with the best patient outcome, with regards to hospital stay and post-operative complications, is the placement of one medial to lateral (pectoro-axillary) drain with low negative pressure. Ideally, the drain should be removed on the second or third postoperative day or when the amount of drained fluid in the last 24 hours reaches below 50 milliliters.
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Affiliation(s)
- George S Stoyanov
- Department of General and Clinical Pathology, Forensic Medicine and Deontology, Faculty of Medicine, Medical University - Varna "Prof. Dr. Paraskev Stoyanov", Varna, Bulgaria
| | - Dragostina Tsocheva
- Department of Surgery, Division of Thoracic Surgery, Faculty of Medicine, Medical University - Varna "Prof. Dr. Paraskev Stoyanov", Varna, Bulgaria
| | - Katerina Marinova
- Department of Surgery, Division of Thoracic Surgery, Faculty of Medicine, Medical University - Varna "Prof. Dr. Paraskev Stoyanov", Varna, Bulgaria
| | - Emil Dobrev
- Department of Surgery, Division of Thoracic Surgery, Faculty of Medicine, Medical University - Varna "Prof. Dr. Paraskev Stoyanov", Varna, Bulgaria
| | - Rumen Nenkov
- Department of Surgery, Division of Thoracic Surgery, Faculty of Medicine, Medical University - Varna "Prof. Dr. Paraskev Stoyanov", Varna, Bulgaria
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