Falciform flap suturing reduces seroma and drain duration in mastectomy±axillary dissection: a retrospective cohort study

Breast cancer represents the most common malignancy among women worldwide, with surgery serving as the primary treatment modality. Postoperative seroma constitutes one of the most frequent complications, with reported incidence rates ranging from 3% to 93% depending on the surgical procedure performed. Seroma formation is associated with surgical site infection, upper extremity lymphedema, and delays in adjuvant chemotherapy and radiotherapy. Although conventional negative pressure drainage remains widely utilized, it often fails to adequately obliterate the surgical dead space. In contrast, flap fixation techniques, including falciform flap suturing, may reduce seroma formation by mechanically approximating the subcutaneous tissue to the underlying chest wall. This retrospective study reviewed the clinical data of 137 patients with breast cancer who underwent unilateral mastectomy with or without axillary lymph node dissection at the Breast Department of Guangdong Provincial Hospital of Chinese Medicine between January and October 2023. Patients were divided into two groups: the intervention group( n =57), in which negative pressure drainage was combined with falciform flap suturing(3 − 0 silk interrupted sutures were used to approximate the subcutaneous flap to the chest wall fascia to obliterate the dead space), and the control group(n༝80) received negative pressure drainage alone. The primary outcome measures were the time to removal of the first and second drainage tubes and the incidence of seroma. The secondary outcome was wound healing. To adjust for potential confounding factors, including body mass index (BMI), diabetes history, and neoadjuvant therapy status, multivariable linear regression analysis was performed for drainage tube removal time, and multivariable logistic regression analysis was conducted for seroma incidence. These statistical approaches were applied to identify the independent association between falciform ligament flap suturing and the study outcomes. The clinical outcomes demonstrated significant intergroup differences in drainage tube indwelling time. The median initial extubation time was 5 days in the falciform ligament flap suturing group versus 6.5 days in the control group ( P < 0.01); and the median secondary extubation time was 8 days versus 10 days in the two groups, respectively ( P < 0.01). The overall seroma incidence was 7.02% (4/57) in the experimental group, which was significantly lower than 21.25% (17/80) in the control group ( P = 0.023). Multivariable regression analysis further confirmed that falciform ligament flap suturing was an independent influencing factor for initial and secondary extubation time. Specifically, this technique reduced the first extubation time (β=−1.467, P < 0.01) and secondary extubation time (β=−2.631, P < 0.01), explaining 12.7% and 8.7% of the total variation in drainage tube removal time, respectively. Combined falciform ligament flap suturing and vacuum drainage effectively reduces postoperative drainage tube indwelling time and seroma formation. Owing to its technical simplicity and cost-effectiveness, this approach can be widely implemented in hospitals of all levels. Prospective multicenter randomized controlled trials (RCTs) are required to confirm its long-term therapeutic outcomes and synergistic benefits in conjunction with other interventions including fibrin glue application.