# A Prospective Comparative Study of the Effectiveness of Flap Fixation by Suture Versus Conventional Closure in Reducing Seroma Formation After Modified Radical Mastectomy

## TL;DR

This study shows that using sutures to fix flaps during mastectomy reduces seroma formation and speeds up recovery without increasing complications.

## Contribution

The study provides empirical evidence that flap fixation with axillary exclusion reduces seroma incidence after mastectomy.

## Key findings

- Flap fixation reduced seroma incidence to 11.1% compared to 41.7% in conventional closure.
- Drain output was significantly lower in the flap fixation group (306.67 mL vs. 531.11 mL).
- Drain removal occurred earlier in the flap fixation group (4 days vs. 6.25 days).

## Abstract

Background

Seroma formation is a common postoperative complication of modified radical mastectomy (MRM), leading to delayed wound healing, increased infection risk, and prolonged hospital stays. Flap fixation by suture has been proposed to reduce seroma incidence, but its efficacy remains to be established.

Methods

A prospective comparative study was conducted at a tertiary referral center in central India from April 2019 to March 2020, involving 72 patients undergoing MRM for breast cancer (BC). Patients were divided into two groups: the study group (n = 36) underwent flap fixation with axillary exclusion by fine interrupted absorbable sutures, while the control group (n = 36) underwent conventional wound closure. Outcomes assessed included seroma incidence, drain duration, total drain output, and postoperative morbidities such as pain, surgical site infection (SSI), and flap necrosis.

Results

Patients in the flap fixation with axillary exclusion group had significantly reduced total drain output (mean: 306.67 mL versus 531.11 mL, p<0.01) and earlier drain removal (mean: 4 days versus 6.25 days, p<0.001) compared to the control group. The incidence of seroma was significantly lower in the study group (11.1% versus 41.7%). Postoperative pain, flap necrosis, and SSI were comparable between the groups signifying that flap fixation with axillary exclusion does not increase the morbidity with acceptable cosmesis.

Conclusion

Flap fixation with axillary exclusion by suture effectively reduces seroma formation and accelerates recovery without compromising patient comfort or mobility, representing an improved technique for MRM closure.