J Cancer 2019; 10(15):3481-3485. doi:10.7150/jca.29774

Research Paper

The use of ultrasonic scalpel lowers the risk of post-mastectomy seroma formation in obese women

Tomasz Michalik1, Rafal Matkowski1,2, Przemyslaw Biecek3, Bartlomiej Szynglarewicz1,2✉

1. Breast Unit, Lower Silesian Oncology Center - Regional Comprehensive Cancer Center, Plac Hirszfelda 12, 53-413 Wroclaw, Poland
2. Department of Oncology, Faculty of Postgraduate Medical Training, Wroclaw Medical University, Plac Hirszfelda 12, 53-413 Wroclaw, Poland
3. Faculty of Mathematics and Information Science, Warsaw University of Technology, Koszykowa 75, 00-662 Warsaw, Poland

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Michalik T, Matkowski R, Biecek P, Szynglarewicz B. The use of ultrasonic scalpel lowers the risk of post-mastectomy seroma formation in obese women. J Cancer 2019; 10(15):3481-3485. doi:10.7150/jca.29774. Available from http://www.jcancer.org/v10p3481.htm

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Introduction: Seroma formation (SF) is the most common postoperative complication after mastectomy and axillary surgery. The aim of this study was to assess its incidence and risk factors following a modified radical mastectomy in breast cancer patients.

Materials and methods: 271 patients who underwent a modified radical mastectomy (250 with traditional electrocautery and 21 with an ultrasonic scalpel) were studied. The SF rate was calculated and its association with patient-related factors, surgical features and postoperative variables was assessed and statistically analyzed with P<0.05 as a significance threshold.

Results: SF was observed in 18% of patients. Patient's age, operating time and number of removed axillary lymph nodes did not significantly differ between SF and non-SF patients. Patients BMI, total drainage amount, number of days with drain were higher and postoperative hospital stay was significantly longer in SF patients (P<0.001 each). The dissection instrument was also an important risk factor: SF developed in 20% of patients operated with electrocautery and in none with an ultrasonic scalpel (P<0.05). The association between surgical instrument and the number of removed lymph nodes, patient's age and BMI was not significant. Dissection with an ultrasonic scalpel resulted in a statistically significant lower total drainage amount. However, it was also related to a significantly longer operating time (P<0.001 each).

Conclusions: Risk of SF after a modified radical mastectomy is significantly higher in patients with obesity. Despite longer operating time, using an ultrasonic scalpel is a valuable option in those cases because it lowers the total drainage amount and seems to be an important protective factor against SF.

Keywords: Breast cancer, Mastectomy, Seroma formation, Obesity, Ultrasonic scalpel