# Analysis of Seroma Formation, Flap Necrosis, and Postoperative Pain Following Modified Radical Mastectomy in Patients With Breast Cancer: A Prospective Study

## TL;DR

This study examines common complications after modified radical mastectomy in breast cancer patients, finding that factors like age, BMI, and cancer stage are linked to issues like seroma, flap necrosis, and pain.

## Contribution

The study provides new insights into the associations between patient-specific factors and postoperative complications following modified radical mastectomy in breast cancer patients.

## Key findings

- 20% of patients developed flap necrosis and 26% experienced seroma after modified radical mastectomy.
- Age and BMI were significantly associated with pain severity and seroma formation, respectively.
- Cancer stage correlated with flap necrosis, and seroma was linked to higher pain levels at multiple postoperative time points.

## Abstract

Background

Breast cancer is one of the leading malignancies among Indian women, and it remains a significant contributor to the global cancer burden. Modified radical mastectomy (MRM), which involves removing the entire breast, nipple-areola complex, and axillary lymph nodes, is commonly performed. However, postoperative complications such as seroma formation, pain, and flap necrosis significantly impact patient recovery and quality of life.

Objective

This study aimed to evaluate the prevalence and presentation of seroma and flap necrosis, analyze the severity and distribution patterns of post-MRM pain, and assess associations between these complications and clinical parameters.

Methods

This prospective cohort study was conducted at a single tertiary-care center, Department of General Surgery, Ganesh Shankar Vidyarthi Memorial (GSVM) Medical College, Kanpur, India, from December 2022 to November 2024. One hundred consecutive patients with histologically confirmed breast carcinoma who were planned for MRM were included; patients aged <18 years, with bilateral disease, prior axillary surgery, prior chest wall radiation, local recurrence, metastatic disease, or undergoing reconstruction or breast-conserving surgery were excluded. Postoperative pain was measured using the validated Visual Analog Scale (VAS) on postoperative days (PODs) 7, 15, 30, 60, and 90. Seroma (assessed on POD 14) and flap necrosis were recorded by clinical examination using predefined surgical criteria. Data were collected using a standardized questionnaire and analyzed with descriptive statistics; Chi-square tests were used for categorical associations, and p < 0.05 was considered significant.

Results

Of 100 patients, 20 (20%) developed flap necrosis, and 26 (26%) experienced seroma. Age showed a significant association with pain severity on POD 7 (χ² = 18.487, p < 0.05) and seroma occurrence (χ² = 7.894, p < 0.05). BMI was strongly associated with seroma formation (χ² = 20.252, p < 0.05). Cancer stage correlated significantly with flap necrosis (χ² = 16.715, p < 0.05). Patients with seroma reported higher pain levels on POD 15 (p < 0.05), POD 30 (p < 0.05), and POD 90 (p < 0.05).

Conclusion

The findings emphasize the importance of patient-specific risk factor evaluation, including age, BMI, and cancer stage, to prevent complications and optimize postoperative care strategies. Early intervention and improved surgical techniques are essential to minimize seroma, flap necrosis, and pain severity after MRM.