Abstract

Background: Modified Radical Mastectomy is the most common procedure which is done for carcinoma breast in this part of the world. Normally MRM is done with two drains in which one is in the axillary area and the other is in the pectoral region so as to prevent seroma and hematoma formation. The drains are inserted to shorten the recovery period and reduce the incidence of seroma which is the most common post operative complication. The drainage of the pectoral region with a separate drain is still a controversial issue which needs to be settled.

Aim: To compare outcome of axillary drain versus axillary and flap drain in Modified Radical Mastectomy.

Methods: 64 patients who agreed to be the part of the study were randomly allocated into 2 groups of 32 each. Group I (n=32) had drain only inserted in the axilla while Group II (n=32) had drain inserted both in axilla and pectoral region. Surgeries were performed by 5-years-post-fellowship consultants. Flaps were made with the scalpel while axilla was dissected with the scissors. The size of the drain was constant with a constant negative suction pressure. The technique would be considered effective with a better outcome measured on the basis of less number of cases of seroma formation, less time and volume of drainage from the drain and complications.

Results: The seroma formation was the most common complication and it was found that 16 out of 32 in group I developed seroma while in group II 10 out of 32 had the same problem. Overall 26 patients out of 64 developed seroma which makes up 40.6% of patients while the volume of seroma was 165.7ml ±53.3 in group I and 143ml ± 61.8 in Group II which is statistically insignificant. The mean of the volume of drainage was 312ml ±36 in group I while it was 297 ml ±28 in Group II which is statistically insignificant. The drain was placed inside for 5.7 ± 2.1 days in group I compared to 4.8±1.5 days in Group II which is statistically insignificant. The rate of other complications in group I was 9.4% in which 2 out of 32 developed hematoma while one patient developed infection while in group II rate of other complications was 6.25 %. 1 patient out of 32 developed partial flap necrosis and another one developed hematoma.

Conclusion: MRM should be performed with drainage at pectoral region. There was significant difference in the percentage comparison of seroma formation as shown by the results of both groups.

Keywords: Radical mastectomy, axilla, hematoma formation