Quilting: A Cost-effective Technique to Reduce Seroma after Mastectomy

Introduction: Seroma is the most common complication after mastectomy. Various previously reported methods have all been ineffective in preventing seroma and therefore, drains are traditionally used. Mechanical closure of the dead space using quilting sutures has been found to reduce the incidence of seroma. The aim of this study was to examine the effect of quilting on postoperative seroma formation after mastectomy in patients who underwent quilting compared to those who underwent conventional wound closure. Methods: We retrospectively reviewed all patients who underwent a mastectomy between 2020 and 2023. In the quilting technique, mastectomy skin flaps were sutured to the pectoralis major muscle or fascia by interrupted deep dermal sutures using size 3/0 absorbable multifilament suture with round-body needle. Only one drain was used and it was removed if output was less than 30 ml per 24 hours for 3 consecutive days. Results: 44 patients underwent conventional wound closure and 32 had quilting suture. On the first postoperative day, patients who underwent quilting had approximately 33% less volume of drainage than those with conventional wound closure (71.7 vs 106.7 ml, P = 0.006). Quilting suture was associated with a shorter time to drain removal (8.35 vs 13.1 days, P = 0.007). There was no difference in terms of surgical site infection and other wound complications, including hematoma and wound dehiscence. Conclusion: Quilting sutures after mastectomy reduces postoperative seroma and time to drain removal by 30-40% compared to conventional wound closure. Quilting reduces healthcare consumption through reduction in wound complications, less clinic visits, shorter hospital stays and less patient discomfort.