External compression dressing versus standard dressing after axillary lymphadenectomy

Closed-catheter drainage after axillary lymph node dissection (ALND) for breast cancer may constitute a significant inconvenience to the recovering patient, and may also serve as portals of entry for bacteria. Any intervention that could reduce the volume and duration of postoperative drainage would be beneficial. The purpose of this study was to determine whether an external compression dressing after ALND would decrease postoperative drainage, afford earlier drain removal, and reduce subsequent seroma formation.

One hundred thirty-five women undergoing definitive surgical treatment for breast cancer were randomized to receive a compression dressing (n = 66) or standard dressing (n = 69). They were also stratified for modified radical mastectomy (MRM; n = 74) or breast conservation therapy (BCT; n = 61). All patients had ALND. The compression dressing consisted of a circumferential chest wrap of two 6-inch Ace bandages, held in place by circumferential Elastoplast bandage, and it was applied by the same nurse. This dressing remained intact until postoperative day 4. Patients in the standard dressing group (control) were fitted with a front-fastening Surgibra only. Drains were removed when the total daily amount was <50 cc. Postoperative drainage volume, total days with drain, and frequency of seroma formation were recorded for each patient.

After 4 days, wound drainage in both groups was nearly identical (compression = 490 cc, standard = 517 cc; P = 0.48). Total days with drain were also similar (compression = 6.4 days, standard = 6.1 days; P = 0.69). The compression dressing did not reduce seroma formation. In fact, there was a statistically significant increase in the number of seroma aspirations per patient in the compression group (compression = 2.9, standard = 1.8; P <0.01). The increase in seroma aspirations was more significant in MRM patients (compression = 3.1, standard = 1.7; P <0.01) than in BCT patients (compression = 2.6, standard = 1.8; P = 0.20).

External compression dressing fails to decrease postoperative drainage and may increase the incidence of seroma formation after drain removal. Thus, routine use of a compression dressing to reduce postoperative drainage after ALND for breast cancer is not warranted.