A Comparative Study between Mastectomy Flap Quilting Sutures with Axillary Compression versus Conventional Sutures with Axillary & Pectoral Drain in Reducing Post-Modified Radical Mastectomy Seroma

Abstract

Introduction: Seroma formation remains a common complication following modified radical mastectomy (MRM), often prolonging hospital stay and increasing morbidity. Quilting sutures with axillary compression have been proposed as an alternative to conventional sutures with axillary and pectoral drains to reduce seroma incidence.

Aim & Objective: This study aims to compare mastectomy flap quilting sutures with axillary compression versus conventional sutures with axillary and pectoral drain in reducing post -modified radical mastectomy Seroma.

Material & Methods: This comparative study included 70 patients undergoing MRM, divided into two groups: quilting sutures with axillary compression (n=35) and conventional sutures with axillary and pectoral drains (n=35). Patient demographics, disease characteristics, operative parameters, postoperative drain volumes, seroma incidence, and complications were analyzed.

Results: Baseline patient and disease characteristics were comparable between groups (p>0.05). Quilting sutures significantly reduced operative time (122.64±12.62 vs. 134.38±14.48 min, p<0.001), blood loss (188.92±42.46 vs. 222.54±78.76 ml, p=0.029), total drain volume (995.55±352.64 vs. 1391.78±398.26 ml, p<0.001), and hospital stay (7.23±2.14 vs. 13.56±3.76 days, p<0.001). Seroma incidence was markedly lower in the quilting group (14.3% vs. 40.0%, p=0.016). Postoperative complications such as surgical site infection, flap necrosis, and wound gaping showed no significant difference between groups.

Conclusion: Quilting sutures with axillary compression significantly reduce seroma formation, operative time, drain volume, and hospital stay compared to conventional sutures with drains, without increasing postoperative complications. This technique offers a safe and effective alternative in MRM.

REFERENCES

1. Mehrotra R, Yadav K. Breast cancer in India: present scenario and the challenges ahead. World J Clin Oncol. 2022;13:209-218. https://doi.org/10.5306/wjco.v13.i3.209
2. Bhagchandani M, Shukla V, Maurya RK. A comparative study between mastectomy flap quilting sutures with axillary drain versus conventional sutures with axillary and pectoral drain in reducing postmodified radical mastectomy seroma formation. Indian J Surg. 2023;85:1-6. https://doi.org/10.1007/s12262-023-03756-6
3. Manjunath P, Yelamanchi R, Agrawal H. Effect of mastectomy flap fixation on post-operative fluid drainage and seroma formation in breast cancer patients: a double-blinded randomized controlled trial. Pol Przegl Chir. 2022;95:181-186. https://doi.org/10.5604/01.3001.0015.8569
4. Unger J, Rutkowski R, Kohlmann T. Potential risk factors influencing the formation of postoperative seroma after breast surgery: a prospective study. Anticancer Res. 2021;41:859-867. https://doi.org/10.21873/anticanres.14838
5. Adrien C, Katia M, Marie-Lucile B. Prevention of lymphocele or seroma after mastectomy and axillary lymphadenectomy for breast cancer: systematic review and meta-analysis. Sci Rep. 2022;12:1-8. https://doi.org/10.1038/s41598-022-13831-9
6. Jayalal JA, Kumar SJ, Manovah JA, Michael L, Mohamed Haaris. Quilting sutures versus conventional sutures in modified radical mastectomy in reducing post-operative seroma formation: prospective randomized controlled trial. Int J Acad Med Pharm. 2025;7(2):501-505. https://doi.org/10.18203/2349-2902.isj20170219
7. Keshav Prakash S, Ganesh Babu CP, Vinoth Kumar S. Evaluation of quilting technique for reduction of post mastectomy seroma formation: a randomized control study. World J Surg Surgical Res. 2022;5:1-4.
8. Meena SP. A quilting sutures technique for flap closure in patients undergoing modified radical mastectomy for the prevention of seroma: a single-center, randomized controlled trial. J Educ Health Promot. 2024;13:1-6. https://doi.org/10.4103/jehp.jehp_47_24
9. Raju A, Brahmachari S, Maurya AP. A prospective comparative study of the effectiveness of flap fixation by suture versus conventional closure in reducing seroma formation after modified radical mastectomy. Cureus. 2025;17(5):1-9. https://doi.org/10.7759/cureus.83915
10. Bethsy Priscilla SB, Sumathi M, Athisayamani J, Muthumari K. Evaluating the efficacy of flap quilting sutures vs conventional sutures in reducing post-modified radical mastectomy seroma. Int J Acad Med Pharm. 2025;7(1):11-15. https://doi.org/10.36106/ijsr/2406623
11. Ten Wolde B, van den Wildenberg FJ, Keemers-Gels ME, Polat F, Strobbe LJ. Quilting prevents seroma formation following breast cancer surgery: closing the dead space by quilting prevents seroma following axillary lymph node dissection and mastectomy. Ann Surg Oncol. 2014;21(3):802-807. https://doi.org/10.1245/s10434-013-3359-x
12. Khater A, Elnahas W, Roshdy S, Farouk O, Senbel A, Fathi A, et al. Evaluation of the quilting technique for reduction of postmastectomy seroma: a randomized controlled study. Int J Breast Cancer. 2015;2015:1-6. https://doi.org/10.1155/2015/287398
13. Morarasu S, Clancy C, Ghetu N, Musina AM, Velenciuc N, Iacob S, et al. Impact of quilting sutures on surgical outcomes after mastectomy: a systematic review and meta-analysis. Ann Surg Oncol. 2022;29:3785-3797. https://doi.org/10.1245/s10434-022-11350-5
14. Kumar NV, Hulikal N, Banoth M. A randomized controlled study of quilting with axillary lymphatic ligation versus conventional modified radical mastectomy in patients with breast cancer. Indian J Surg Oncol. 2022;13:245-250. https://doi.org/10.1007/s13193-021-01453-y
15. Larsen BB, Hugan C Jr. Fixation of skin flaps in radical mastectomy by subcutaneous sutures: observations. AMA Arch Surg. 1955;71:419-423. https://doi.org/10.1001/archsurg.1955.01270150113013
16. Inwang R, Hamed H, Chaudary MA, Fentiman IS. A controlled trial of short-term versus standard axillary drainage after axillary clearance and iridium implant treatment of early breast cancer. Ann R Coll Surg Engl. 1991;73:326-328.