Reduction of seroma by pectoralis fascia dissection using an energy device in total mastectomy for breast cancer: An observational study 

Seroma formation is one of the unresolved complications of breast cancer surgery. The use of energy devices (EDs) can improve breast cancer surgery outcomes. Dissection of the pectoralis fascia is an important process in total mastectomy, which involves a wide area of the posterior wall of the mammary glands. The current study investigated whether using EDs for this process could lead to a reduction in seroma formation or potentially reduce other complications. In the present observational study, the use of an ED for pectoralis fascia dissection was compared with conventional electrocautery. The main outcomes were the total amount of drainage (total AD), amount of drainage per day and adverse events (AEs) after propensity score matching (PSM). in addition, a univariate analysis of AE occurrence was performed. Overall, 41 and 117 patients were included in the ED and control groups, respectively. PSM was performed for three covariates: Presence or absence of axillary dissection, preoperative chemotherapy and body mass index >25 kg/m². Compared with those in the control group, the total AD post‑PSM in the ED group did not decrease (P=0.1778), whereas the amount of drainage per day was markedly decreased on postoperative day 8 in the ED group. In the univariate analysis, only the use of ED was associated with a reduction in AEs requiring intervention; other factors showed no significant association. The frequency of AEs requiring intervention was significantly lower in the ED group than that in the control group post‑PSM (P=0.0372). Notably, seroma accounted for most AEs. The results of the present study suggested that pectoralis fascia dissection using an ED may reduce fluid drainage and the incidence of AEs. This simple modification suggests the possibility of improving surgical techniques and is expected to contribute to favorable surgical outcomes.