The significance of perioperative glucocorticoids in the prevention of seroma formation after mastectomies: a systematic review and meta-analysis

TL;DR

This study finds that using glucocorticoids before or after mastectomies may help reduce the risk of seroma formation, a common surgical complication.

Contribution

The paper provides the first systematic review and meta-analysis on the effectiveness of perioperative glucocorticoids in preventing seromas after mastectomy.

Findings

Perioperative glucocorticoids significantly reduced the rate of seroma formation compared to placebo.

Glucocorticoids also decreased total drainage volume and shortened the time to drain removal.

A higher trend in wound infection rates was observed in the glucocorticoid group, though not statistically significant.

Abstract

Seroma formation is one of the most common complications after mastectomy. Seromas can lead to repeated aspirations, increase the risk of infection, and potentially delay oncologic treatment. Several strategies have recently been employed to prevent seromas, but there is no definitive standard. We aim to determine whether perioperative glucocorticoids (GC) are safe and effective in preventing seromas in patients undergoing mastectomy.

We performed a systematic search in five databases on November 12, 2024. Eligible studies included women who underwent mastectomy and received perioperative GCs. Results are reported as risk ratios (RR), odds ratios (OR), or mean differences (MDs) with 95% confidence intervals (CIs), and are presented as forest plots. A random-effects model was used to pool effect sizes.

Altogether, 13 studies (12 RCTs and 1 case–control study) with 1011 patients were included; all were eligible for meta-analysis. The rate of seroma formation was significantly lower in the GC groups compared to the placebo groups (RR = 0.56, CI 0.38; 0.82, p = 0,008). Total volume of drainage (MD = -213.36 ml, CI -312.5; -114.22, p = 0.001) and days to drain removal (MD =—3.01 days, CI -4.06; -1.96, p = 0.001) were also lower in the GC groups. The rate of wound infection showed a higher trend in the intervention groups (RR = 1.26, CI 0.82; 1.92, p = 0.224), although the results did not reach statistical significance,

Our results suggest that perioperative glucocorticoid administration may reduce seroma formation in patients undergoing mastectomy. A potential increase in wound infection rates was also observed, but this requires further investigation.

The online version contains supplementary material available at 10.1007/s10549-025-07830-3.

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