title: A randomised study of axillary drainage and pectoral fascia preservation after mastectomy for breast cancer.
abstract: BACKGROUND
  To reduce the risk of seroma after modified radical mastectomy in breast cancer patients, the use of suction axillary drainage is a standard procedure. The optimal time to remove the drain is not established. Whether the removal or preservation of the pectoral fascia influences the risk of seroma formation or loco-regional recurrence rate remains unclear.
  
  
  METHODS
  The trial included 247 patients with breast cancer who underwent modified radical mastectomy in five Swedish hospitals 1993-1997. The median follow-up time was 6 years. One hundred and twenty-two and 125 patients, respectively, were randomised between removal versus preservation of the pectoral fascia. Of these 247 patients a total of 198 patients were also randomised to have the drain removed 24 h postoperatively or to keep the drain in until discharge had decreased to less than 40 ml/24 h.
  
  
  RESULTS
  Early removal of the axillary drain was associated with significantly more seromas and a shorter average postoperative hospital stay. There were no differences between the two groups regarding the rate of wound infections and/or hematoma formation. Removal or preservation of the pectoral fascia did not influence the formation of seroma or the amount of peroperative bleeding. A trend towards an increased risk for chest wall recurrence was observed in patients with preserved pectoral fascia (16/125 compared with 8/122; hazard ratio=2.0, 95% confidence interval=0.9-4.7).
  
  
  CONCLUSIONS
  Early removal of axillary drain shortened the duration of hospital stay without any increase in wound complications. However, it yielded a significantly higher incidence of seroma. Seroma formation and the chest wall recurrence rate was not significantly influenced by the preservation of the pectoral fascia or not.
authors.affiliation: Department of Surgery, Uppsala University Hospital, Uppsala, Sweden. kristina.dalberg@kirurgi.uas.lul.se
authors.forename: K
authors.initials: K
authors.lastname: Dalberg
authors.forename: H
authors.initials: H
authors.lastname: Johansson
authors.forename: T
authors.initials: T
authors.lastname: Signomklao
authors.forename: L E
authors.initials: LE
authors.lastname: Rutqvist
authors.forename: L
authors.initials: L
authors.lastname: Bergkvist
authors.forename: J
authors.initials: J
authors.lastname: Frisell
authors.forename: G
authors.initials: G
authors.lastname: Liljegren
authors.forename: T
authors.initials: T
authors.lastname: Ambre
authors.forename: K
authors.initials: K
authors.lastname: Sandelin
mesh_terms: D000368:Aged; D001365:Axilla / Q000601:surgery*; D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D003131:Combined Modality Therapy; D000071938:Fasciotomy; D005260:Female; D006406:Hematoma / Q000209:etiology; D006801:Humans; D007902:Length of Stay; D008196:Lymph; D008408:Mastectomy / Q000009:adverse effects / Q000379:methods*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D010369:Pectoralis Muscles; D011446:Prospective Studies; D011960:Receptors, Estrogen / Q000032:analysis; D013396:Suction / Q000379:methods; D013530:Surgical Wound Infection / Q000209:etiology; D016896:Treatment Outcome
chemical_list: D011960:Receptors, Estrogen