Influence of surgical technique on axillary seroma formation: a randomized study.

The aim of this study was to evaluate the influence of surgical technique in the form of electrocautery and suction drains on seroma formation following surgery for breast cancer. A prospective randomized study was carried out. One hundred and sixty patients with breast cancer who underwent surgery were allocated to four arms using a 2 x 2 factorial design. This method enabled us to evaluate the independent effect of two different causative factors on the incidence of postoperative seroma formation using a single dataset with limited numbers. The main outcome measure was postoperative seroma formation defined as a postoperative axillary collection requiring more than one aspiration after removal of the drain. The incidence of seroma in our institution is 90%. Incidence of postoperative seroma was 88.3% if electrocautery was used, which reduced to 82.2% if surgery was carried out using scissors for dissection and ligatures for haemostasis (P = 0.358). There was no influence on the incidence of seroma formation whether suction drain (84.6%) or corrugated drains (86.1%) were used (P = 0.822). The use of electrocautery in axillary dissection does not adversely affect postoperative seroma formation after surgery for breast cancer. The use of different drainage techniques has no bearing on the postoperative seroma formation. The surgical technique has no influence on the rate of seroma formation after surgery for breast cancer.

Breast conservation surgery without pre-operative mammography--a definite feasibility.

Mammography is mandatory before breast conservation. Its limited availability in developing countries has discouraged surgeons in rural areas from practicing breast conservation. We analyzed the database of breast surgeries at our institute to investigate whether breast conservation could be safely performed if clinically feasible without the use of mammography. If mammography had not been performed in the 735 patients undergoing surgery, breast conservation could have been erroneously performed in 38 (5.17%) patients; 13 had impalpable mammographic multicentricity and 25 had extensive microcalcifications. A detailed analysis showed that this error in decision would have been detected and rectified in each of the above patients before commencement of radiotherapy. We conclude that although mammography cannot be totally excluded from the treatment algorithm for palpable breast cancer, conservative surgery can be offered in clinically suitable cases even if pre-operative mammography is not available due to limited resources in the developing world.