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August 1995

Axillary Lymphadenectomy for Breast Cancer Without Axillary Drainage

Author Affiliations

From the Departments of Surgery (Dr Jeffrey) and Radiology (Drs Ikeda and Birdwell), Stanford (Calif) University School of Medicine, and the Departments of Surgery (Dr Goodson) and Anesthesia (Dr Bogetz), University of California, San Francisco, School of Medicine.

Arch Surg. 1995;130(8):909-913. doi:10.1001/archsurg.1995.01430080111018

Objective:  To evaluate axillary lymph node dissection done without closed drainage in conjunction with breast conservation cancer surgery.

Design:  Prospective clinical study.

Setting:  Two university hospitals.

Patients:  Eighty-one women undergoing wide local excision of breast cancer with simultaneous or subsequent axillary lymph node dissection.

Interventions:  No axillary drain was placed following axillary lymphadenectomy.

Main Outcome Measures:  The development and resorption of axillary seroma fluid as measured by clinical aspiration and serial sonographic examination.

Results:  Thirty-four (42%) of the 81 women required axillary seroma aspiration even though axillary fluid was present in 92% (22/24) of those studied sonographically. The seromas accumulated over the first 2 weeks following axillary dissection and resorbed over the next 2 weeks, as assessed by both clinical and sonographic examination. The complication rate was 2% (2/81). The surgery was performed safely on an outpatient or short-stay basis in 99% (80/81) of patients. All patients except one were discharged within 23 hours of surgery, and 56 patients were discharged directly after anesthesia.

Conclusion:  Axillary lymph node dissection done in conjunction with breast conservation surgery can be performed in an ambulatory or short-stay setting without axillary drainage. Postoperative seromas will resolve within 1 month, and fewer than half will require aspiration. Lymphadenectomy without drainage reduces morbidity and allows the patient greater personal comfort.(Arch Surg. 1995;130:909-913)