The impact of drains on postoperative seroma and infection after mastectomy: A retrospective study in Danish women with breast cancer

INTRODUCTION: Postoperative drains are commonly used after mastectomy to reduce seroma formation, but evidence of the benefit remains unclear. We evaluated the effect of postoperative drains on seroma formation and infection after mastectomy in a retrospective institutional study.

MATERIALS AND METHODS: We compared women with breast cancer who had mastectomy with or without suction drain in 2020. Data were retrieved from original patient files. Odds ratios (OR) and 95% confidence intervals (CI) for seroma and infection risk were calculated using logistic regression, and seroma volume was analysed with linear regression.

RESULTS: We included 471 women, whereof 279 had drain and 192 had no drain. Infection rates and, among women with seroma, total seroma volume did not differ significantly by drain status. More women in the drain group did not require seroma puncture, 76 (27%), compared to the no-drain group, 29 (15%) (P < 0.001). In a multiple analysis, drains combined with local methylprednisolone injection significantly reduced the risk of seroma formation in women undergoing sentinel lymph node biopsy (OR: 0.46; 95% CI, 0.26-0.82, P = 0.008), but not in women with axillary lymph node dissection. Seroma formation risk was higher in current smokers (OR: 2.42; 95% CI, 1.12-5.20, P = 0.024) and women with BMI ≥30 (OR: 3.32; 95% CI, 1.60-6.88, P = 0.001).

CONCLUSION: The use of postoperative drain in combination with methylprednisolone injection reduced the risk of seroma in women undergoing sentinel lymph node surgery. Current smokers and women with high BMI had an increased risk of seroma formation.