Quilting reduces post-operative seroma in mastectomy patients

Background: The consensus development conference on treatment of breast cancer in 1979stated that the modified radical mastectomy was the standard of treatment for stages I and IIbreast cancer. Surgeons have faced several problems such as seroma, hematoma, necrosis of the skin flap, breakdown of the wound, infection and they should be aware of the morbidity uniqueto mastectomy and axillary node dissection. One of the most frequently encountered complications following mastectomy is seroma formation. It causes significant morbidity, whichmay also lead to surgical site infection, delayed wound healing and frequent outpatient visits for seroma aspiration.
Objective: To evaluate the effect of surgical quilting after mastectomy in the prevention of postoperative seroma.
Methods-This was a single center prospective cohort study over a period of 1 year, with asample size of 97. Considering the inclusion and exclusion criteria, patients with carcinoma breast presenting to the Department of General Surgery, ESIC-PGIMSR Bangalore constitute the study group. Group 1 patients (quilting) had mastectomy flaps sutured to pectoral muscle using interrupted absorbable sutures. Seroma requiring aspiration, number of aspirations and volume aspirated were recorded postoperatively.
Results: During the study period, 97 patients were studied, with 54 patients in group 1 (quilting)and 43 patients in group 2 (non-quilting). The proportion of patients who developed seromarequiring aspiration was 69% (n=30) in the non-quilting group and 29% (n=16) in the quiltinggroup (p<0.001). Additionally, the total volume of seroma drained was 427 mL (standard error (SE)=69) in the non-quilting group and 63 mL (SE=21) in the quilting group (p=0.0008).
Conclusion: Quilting of the mastectomy flaps significantly reduces seromaformation. Both total volume of seromaaspirated, and number of aspirations are significantly reduced using this technique.