Seroma Formation After Mastectomy and Axillary Dissection; A Comparison Among Blunt Dissection With Hemostat, Sharp Dissection With Metzenbaum Scissors, and Dissection With Harmonic Scissors

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Faramarz Karimian
Hesam Kondori
Seyed Mostafa Mosavi-Zadeh
Mohamadreza Neishaboury
Ali Abbaszadeh-Kasbi
Mohammad Reza Keramati


Harmonic scissors, Seroma, Breast cancer, Axillary lymph node dissection, Sentinel lymph node biopsy, modified radical mastectomy, Breast conservation surgery


Background: Seroma formation is a common complication after surgery for breast cancer. It may originate from dissected lymphatic ducts in axillary area. Two important predictive factors are the surgical technique, and instruments used during surgery. This study was conducted to determine the impact of three axillary dissection techniques, namely, blunt dissection with hemostat, sharp dissection with Metzenbaum scissors, and dissection with harmonic scissors, on seroma formation.
Methods: Patients with a tissue diagnosis of breast cancer who did not have metastasis, and were candidates for either breast conservation surgery (BCS) and sentinel lymph node biopsy (SLNB) with or without axillary lymph node dissection (ALND), or modified radical mastectomy (MRM) were included in a prospective study. Patients were randomly allocated to one of the above mentioned three groups. The incidence of seroma formation was compared among the groups.
Results: Sixty patients (age: 50.25 ± 10.33 years) were enrolled for the study. At the end of the study, after four weeks of postoperative follow up, 19 patients developed seroma (31.6%), of whom 5 (26.3%) had dissection with harmonic scissors, 6 (31.5%) with Metzenbaum scissors, and 8 (42.1%) were dissected bluntly. There was no significant difference among groups regarding seroma formation (P = 0.583).
Conclusion: Application of harmonic scissors for axillary dissection has no significant impact on seroma formation. However, MRM leads to significantly more seroma formation compared with BCS.