All patients had one closed suction drain inserted through the medial end of the incision. Axillary dissection was performed either by way of sentinel lymph node biopsy (SLNB), SLNB followed by axillary clearance of levels I and II, or axillary clearance of levels I and II only. The dissection of mastectomy flaps was performed with diathermy and the dissection of the axillary part as a sharp dissection. Surgery was performed on all patients using the same technique irrespective of their randomization. The study was planned as a clinical pilot study with drainage volume, seroma volume after removal of drains, number of punctures for seroma and wound complications as the end targets. If the patients were randomized to receive glucocorticoid, an intravenous injection of 125 mg methylprednisolone sodium succinate was given as a single bolus 1.5 hours before the start of surgery. The envelopes indicated to which group the patient belonged. Informed, written consent was obtained and the patients were randomized to the administration of glucocorticoid or no medical treatment randomization was performed by means of sealed envelopes, prepared and numbered in random order by a consultant who did not participate in the study. MATERIAL AND METHODSÄuring a 12-month period, patients with operable primary breast cancer scheduled for mastectomy and axillary dissection and meeting the inclusion criteria of this study (Table 1) were included. In a randomized pilot study, we measured whether a single dose of 125 mg methylprednisolone sodium succinate administered intravenously to breast cancer patients immediately before mastectomy would reduce the drainage volume or subsequent seroma formation. On this basis, we raised the hypothesis that steroid administration would have a prophylactic effect on seroma formation. ![]() Even a larger single dose of glucocorticoid (30 mg/kg) used to reduce postoperative complications in abdominal surgery did not increase rates of surgical complications. In several studies on head and neck surgery, oedema in the surgical area was reduced after a single dose of 125 mg methylprednisolone sodium succinate with no increase in surgical complications. Studies have shown that even a low steroid dose inhibited the postoperative inflammatory response. By paying attention to factors influencing the duration and intensity of the first phase of wound repair, it may be possible to prevent or to reduce the occurrence of seroma. This indicates that seroma is an acute inflammatory reaction during the first phase of wound repair, more so than a passive accumulation of serum. Other factors like proteinases, proteinase inhibitors, different kinds of cytokines (tissue plasminogen activator (tPA), urokinase plasminogen activator (uPA), uPA receptor (uPAR), plasminogen activator inhibitor (PAI) -1, PAI-2, interleukin (IL)-6 and IL-1) are also found in the seroma fluid. The concentration of immunoglobulin G (IgG), leucocytes and granulocytes is higher in patients with seroma than in other patients. ![]() Some papers conclude that preventive measures have to be tailored to the individual patient and operative factors. The following factors had no significant influence on seroma formation: previous biopsy hormone receptor status stage lymph node status and lymph node positivity number of removed lymph nodes number of drains intensity of negative suction pressure duration of drainage removal of drains on the fifth postoperative day versus when the daily drainage volume was decreasing to a minimum type of drainage (closed suction versus static drainage) immobilization of the shoulder or use of fibrinolysis inhibitor. Obesity and a high drainage volume in the initial three days were found to be associated with high formation of seroma. One meta-analysis, 51 randomized controlled trials, seven prospective studies and seven retrospective studies were identified. ![]() Kuroi et al systematically reviewed the literature to identify risk factors for seroma formation. The pathophysiology and mechanism of seroma formation remains controversial and not fully understood. Seroma formation is a common problem after breast surgery.
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