Procedure
swelling, breast cancer, serous, seroma, Seroma
SEROMA, SEROMA, BREAST CANCER
All patients were provided with information about the study in a preoperative consultation and gave their written informed consent on the day before surgery. Included patients were randomized about 24 h before surgery. Randomization was stratified by center, body mass index, and whether or not axillary lymph node dissection was planned. Patients in the control group underwent conventional wound closure using subcutaneous stitches and intradermal sutures with absorbable monofilament to close the skin edges. Patients in the quilting group had the skin flap sutured to the pectoral fascia and then underwent conventional wound closure. The skin flap was fixed with absorbable polyfilament sutures. Two rows of continuous suturing were implemented for the upper and lower skin flaps. When the dead space was not sufficiently closed, one or two additional rows were implemented. Detailed instructions on closure techniques were given to all surgeons. After surgery, all patients underwent vacuum drainage in the mastectomy area and (if axillary lymph nodes had been dissected) in the axillary area. Seroma was then defined as the presence of serous fluid in the mastectomy area. Presence of a seroma was diagnosed by palpation but also according to the patient’s feeling (pain/feeling of swelling or tension). In case of doubt, ultrasound was performed. In the presence of a seroma, the volume was systematically quantified by a puncture. In each center, all operations were performed by experienced breast cancer surgeons. All surgeons used electrocautery for the skin flap dissection.
Esthetic outcomes were evaluated 90 days after surgery by the patient, the surgeons, and an third-party observer (a resident) on a Likert scale (“not at all satisfactory”, “somewhat satisfactory”, “satisfactory”, and “very satisfactory”). The residents evaluated the esthetic outcomes in a single-blind manner.