title: Flap fixation reduces seroma in patients undergoing mastectomy: a significant implication for clinical practice.
abstract: BACKGROUND
  Seroma formation is a common complication following mastectomy for invasive breast cancer. Mastectomy flap fixation is achieved by reducing dead space volume using interrupted subcutaneous sutures.
  
  
  METHODS
  All patients undergoing mastectomy due to invasive breast cancer or ductal carcinoma in situ (DCIS) were eligible for inclusion. From May 2012 to March 2013, all patients undergoing mastectomy in two hospitals were treated using flap fixation. The skin flaps were sutured on to the pectoral muscle using polyfilament absorbable sutures. The data was retrospectively analysed and compared to a historical control group that was not treated using flap fixation (May 2011 to March 2012).
  
  
  RESULTS
  One hundred and eighty patients were included: 92 in the flap fixation group (FF) and 88 in the historical control group (HC). A total of 33/92 (35.9%) patients developed seroma in the group that underwent flap fixation; 52/88 (59.1%) patients developed seroma in the HC group (p = 0.002). Seroma aspiration was performed in 14/92 (15.2%) patients in the FF group as opposed to 38/88 (43.2%) patients in the HC group (p < 0.001).
  
  
  CONCLUSIONS
  Flap fixation is an effective surgical technique in reducing dead space and therefore seroma formation and seroma aspirations in patients undergoing mastectomy for invasive breast cancer or DCIS.
authors.affiliation: Department of Surgery, Atrium Medical Center Heerlen, Heerlen, The Netherlands. jamesvanbastelaar@me.com.
authors.forename: James
authors.initials: J
authors.lastname: van Bastelaar
authors.affiliation: Department of Surgery, Atrium Medical Center Heerlen, Heerlen, The Netherlands. ariannebeckers@hotmail.com.
authors.forename: Arianne
authors.initials: A
authors.lastname: Beckers
authors.affiliation: Department of Surgery, Atrium Medical Center Heerlen, Heerlen, The Netherlands. m.snoeijs@atriummc.nl.
authors.forename: Maarten
authors.initials: M
authors.lastname: Snoeijs
authors.affiliation: Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands. g.beets@me.com.
authors.forename: Geerard
authors.initials: G
authors.lastname: Beets
authors.affiliation: Department of Surgery, Orbis Medical Center Sittard, Sittard, The Netherlands. yv.vissers@orbisconcern.nl.
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Vissers
mesh_terms: D000368:Aged; D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000473:pathology / Q000601:surgery*; D016022:Case-Control Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008408:Mastectomy / Q000009:adverse effects*; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D049291:Seroma / Q000209:etiology / Q000517:prevention & control*; D013524:Surgical Flaps / Q000706:statistics & numerical data*