Effects of local anti-inflammatory drugs on seroma formation after mastectomy and axillary lymph node dissection

Aims: Breast cancer constitutes 32% of all women cancers and this is responsible from 19% of deaths due to cancer in women (1). During their lifetime, one of ten women is suffering from this breast cancer. In 17%-53% of patients on whom modified radical mastectomy is applied, seroma is being developed. Development of seroma is causing in the long term ischemia, necrosis, wound dehiscence and infection in flap due to pressure. Due to the complications established, the patients are staying in hospital for longer times and their treatment costs are increasing. A review of the literature, several studies have shown preventing the seroma formation and reducing the seroma rate. However, such studies couldn?t find practice area at a sufficient level clinically. In the review of the literature, no study was found about comparing the impacts of the antiinflammatory drugs applied locally on the seroma formed after mastectomy.Methods: Due to such reason, it was planned to make an experimental work to prevent the formation of seroma. In this work, synthetic glucocorticoids and COX-2 inhibitor NSAII with low side effects, cheap, easily accessible, easily usable and effective were selected and these were used locally on the seromas established in rats experimentally and then, the antiseromal effects were investigated accordingly. The 30 rats taken for the study were divided into 3 groups and 10 rats were used in each group. Mastectomy and axillary lymph node dissection were applied on the rats in the control group (group 1), physiological serum was used as placebo and the animals were monitored daily. The seroma level formed in the 7th day was measured. It was seen that the seroma volumes were changing between 0,7 cc and 1,8 cc. In the rats that were in Group 1, no flap necrosis or infection was observed. After applying mastectomy and axillary dissection to the 10 rats in Group 2, 0,1 cc 30 mgr/kg dose methylprednisolone sodium succinate (SoluMedrol) was injected locally to these. The rats were monitored daily. The seromas were aspired on the 7th day. It was seen that the volumes of the serous collections were changing between 0 cc and 0.5 cc. Infection was observed in 40% of the rats in this group. After applying mastectomy and axillary dissection to the 10 rats in Group 3, 0,1 cc 0.2 mgr/kg dose meloxicam (Melox amp) was injected locally. The rats were monitored daily. The seromas were aspired on the 7th day in this group, too. It was seen that the volumes of the serous collections were changing between 0,1 cc and 0.7 cc. In the rats of Group 3, no wound infection or flap necrosis have been observed.Findings: When the group 1 was compared with group 2, the rate of the seroma amount formed in the 7th day in group 2 being at low level was statistically significant. When group1 was compared with group 3, the rate of the seroma amount formed in group 3 on the 7th day being at low level was statistically significant. And, when group 2 was compared with group 3, no considerable difference was statistically observed in the effects on formation of seroma. However, infection was seen in 40% of group 2.Results: As a result of this study, it was concluded that methylprednisolone sodium succinate and meloxicam were effective on the seroma formed after mastectomy and axillary dissection however, due to the high risk of wound infection of methylprednisolone sodium succinate, this should not been preferred.For the seromas formed in the site of mastectomy and axillary dissection in the clinic, it is being thought that it would be appropriate to inject locally in the same session in the potential space beneath axillary and pectoral flap 0.2 mg/kg dose meloksikam (Melox amp) by considering the flap surface areas and that such dose would be sufficient to control this complication seen frequently. In order to determine the effect regarding oral NSAII use, further clinical and experimental studies are needed.