Quilting after mastectomy significantly reduces seroma formation

Breast cancer remains one of the leading causes of cancer deaths among women.[1] Simple mastectomy is a common surgical procedure that is used in the management of breast cancer. Seroma is one of the most frequently encountered complications following mastectomy and is a serous fluid that accumulates in the space between the skin flap and underlying tissues. It may cause significant morbidity, including delayed wound healing, and can result in frequent outpatient attendance for seroma aspiration. Repeat aspirations may in turn increase the risk of wound infection and impact on adjuvant treatment, thus compounding patient anxiety during an already difficult time. The incidence of seroma formation after mastectomy has been reported in the literature to vary from 15 to 81%.[2-5] A number of techniques have been employed in an attempt to reduce or prevent seroma formation among mastectomy patients using both mechanical and chemical approaches. However, there is significant heterogeneity in their benefits and there is a paucity of uniform evidence for their use. Quilting is a simple surgical procedure that eliminates the anatomical dead space remaining after mastectomy (Fig. 1). It involves placing interrupted absorbable sutures between the mastectomy flap and pectoral muscle prior to wound closure. It has been described in several studies assessing the technique at donor sites of autologous breast reconstruction.[6-9] However, it has not yet been prospectively investigated in a large patient population in the context of addressing seroma formation following mastectomy. The objective of this prospective study is to evaluate the effect of surgical quilting after mastectomy in the prevention of postoperative seroma and to investigate which factors influence seroma formation.