Seroma formation in two cohorts after axillary lymph node dissection in breast cancer surgery: does timing of drain removal matter?

The purpose of this study was to compare short-term versus long-term axillary drainage in women treated for lymph node positive breast cancer. A comparative cohort study on differences between short-term or long-term axillary drainage was performed. Primary outcome measures were seroma formation demanding aspiration and wound related complications. Secondary outcome measures were type of operation (modified radical mastectomy (MRM) or wide local excision with axillary lymph node dissection (ALND) or completing ALND after positive sentinel node), length of hospital stay, and visits to the emergency department and outpatient clinic. The short-term drainage group consisted of 37 patients, and the long-term drainage group of 40 patients. Short-term drainage was associated with a shorter hospital stay (1.7 versus 2.6 days, p = 0.01), but more visits to the emergency department (0.3 versus 0.1, p = 0.04) and outpatient clinic (3.6 versus 2.8, p = 0.03). Overall incidence of seroma formation was 40% and more frequently in the short-term drainage group (p = 0.01). The highest incidence of seroma and largest aspirated volumes were found in patients with short-term drainage and MRM. No difference in incidence of wound infection was found between both groups, and overall incidence of wound infection was 32%. Seroma formation itself was associated with a higher risk of wound infection (OR 4.39 95% CI 1.6-12.1). Short-term axillary drainage does not lead to an increase in wound-related problems, but is associated with a higher incidence of seroma. This seems especially the case in patients who underwent MRM. Therefore, we propose a differentiated policy: patients treated with MRM should be offered long-term axillary drainage, whereas patients treated with breast conserving therapy and ALND or completing ALND after a positive sentinel node should be offered short-term axillary drainage.