Breast cancer is the most common malignancy among women worldwide and represents a significant public health burden¹. Surgical management remains a cornerstone of treatment, particularly in operable stages of disease². Modified radical mastectomy (MRM), involving complete removal of breast tissue along with axillary lymph node dissection while preserving pectoralis major muscle, continues to be widely performed in many developing countries³.

Postoperative seroma formation is the most common complication following MRM, with reported incidence ranging from 15% to 85%⁴. Seroma represents accumulation of serous fluid in the dead space created after breast and axillary tissue dissection⁵. It may lead to discomfort, infection, flap necrosis, delayed wound healing, and postponement of adjuvant therapy⁶.

To minimize fluid accumulation, closed suction drains have traditionally been placed in both breast and axillary regions⁷. Drains are believed to reduce dead space, prevent seroma formation, and decrease wound-related complications⁸. However, drains themselves are associated with discomfort, increased hospital stay, ascending infection risk, restricted mobility, and psychological distress⁹.

Enhanced recovery after surgery (ERAS) protocols advocate for minimizing invasive devices and promoting early discharge¹⁰. Several recent studies suggest that elimination of routine drainage may not significantly increase complication rates¹¹. Quilting sutures, tissue sealants, and compression dressings have been proposed as alternatives to drains¹².

Despite numerous trials, controversy persists regarding the necessity of routine drainage following MRM¹³. Some studies report higher seroma rates in no-drain groups but no difference in clinically significant complications¹⁴, whereas others show comparable outcomes¹⁵. Additionally, reduced hospital stay and improved patient satisfaction are frequently noted in no-drain protocols¹⁶.

Given the ongoing debate and variability in practice, particularly in resource-limited settings, evaluation of drain versus no-drain policy remains clinically relevant¹⁷. This study aims to compare postoperative outcomes between patients undergoing MRM with and without drains, focusing on seroma formation, wound complications, and hospital stay.

This prospective comparative study was conducted in the Department of General Surgery at a tertiary care hospital over a period of 18 months. Study Population A total of 120 female patients diagnosed with operable carcinoma breast (Stage I–IIIa) and planned for modified radical mastectomy were included. Inclusion Criteria • Female patients aged 18–75 years • Histopathologically confirmed carcinoma breast • Clinical Stage I–IIIa • Undergoing primary MRM • Informed written consent Exclusion Criteria • Metastatic disease • Recurrent breast cancer • Neoadjuvant radiotherapy • Bleeding disorders • Severe comorbidities (uncontrolled diabetes, renal failure) • Immediate breast reconstruction Study Design Patients were randomly allocated into: • Group A (Drain group): Closed suction drains placed in axillary and chest wall region. • Group B (No-drain group): No drains placed; meticulous hemostasis and compression dressing applied. Surgical Procedure All MRMs were performed by experienced surgeons using standardized technique. Axillary lymph node dissection up to level II was performed. In the drain group, suction drains were removed when output was <30 ml/24 hours. Outcome Measures Primary Outcomes: • Seroma formation • Wound infection • Flap necrosis • Hematoma Secondary Outcomes: • Duration of hospital stay • Need for aspiration • Time to adjuvant therapy Follow-up Patients were followed for 30 days postoperatively. Seroma was clinically diagnosed and confirmed by ultrasound when required. Statistical Analysis Data were analyzed using SPSS version 25. Continuous variables were expressed as mean ± SD and compared using independent t-test. Categorical variables were analyzed using Chi-square test. P-value <0.05 was considered statistically significant.

Table 1: Demographic Profile

No statistically significant difference in baseline characteristics.

Table 2: Seroma Formation

Seroma significantly higher in no-drain group.

Table 3: Wound Infection

No significant difference.

Table 4: Flap Necrosis

Comparable rates.

Table 5: Hematoma

No statistical difference.

Table 6: Hospital Stay

Significantly shorter stay in no-drain group.

Seroma remains the most frequent complication following MRM, attributed to disruption of lymphatics and creation of dead space⁴. In our study, seroma incidence was significantly higher in the no-drain group (30%) compared to the drain group (15%), consistent with findings of several randomized trials¹⁸.

However, although seroma rates were higher, most cases were managed conservatively by aspiration, and none resulted in major morbidity. Similar conclusions were drawn by Purushotham et al.¹⁹, who reported increased seroma but no difference in infection or reoperation rates.

Wound infection and flap necrosis rates were comparable between groups, aligning with studies by Srivastava et al.²⁰ and Ten Wolde et al.²¹. This suggests that drains may not significantly influence infectious outcomes when meticulous surgical technique is used.

The most notable advantage of no-drain policy was significantly reduced hospital stay (3.2 vs 6.5 days). Early discharge reduces hospital costs and improves patient comfort²². ERAS guidelines increasingly support minimizing routine drainage to enhance recovery²³.

While drains reduce fluid accumulation, they may prolong hospital stay and restrict mobility²⁴. Some authors advocate selective drainage in high-risk patients rather than universal use²⁵.

Overall, our findings support that although seroma is more frequent without drains, major complications are not significantly increased. With appropriate follow-up and aspiration when required, no-drain MRM may be safely implemented.

No-drain policy in modified radical mastectomy is associated with shorter hospital stay and comparable complication rates, though seroma incidence is moderately increased. Routine drainage may not be mandatory in all patients. Individualized approach is recommended.

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