***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: A prospect i ve audit of seroma formation following  breast-conserving surgery for carcinoma with axillary dissection was carried out . Ninety-seven consecutive patients were studied . The post-operative formation of fluid within the axilla ( seroma ) was recorded on a computerised data collection system . From August 1998 to December 1998 , no drain or other axillary restriction was used . The seroma rate in 27 of these patients who had at least seven nodes in the axillary sample was 14/27 ( 52 % ) . From December 1998 to June 1999 , an additional suture was inserted between the axillary skin and the chest wall ( buttress suture ) . This was design ed to obliterate the axillary space after dissection . There were 37 patients with seven or more nodes in the axillary dissection in this study and of these , nine patients developed a seroma ( 24 % ) ( P=0.007 ) . The use of the buttress suture reduces the seroma rate following axillary dissection without axillary drainage Sixty-seven patients undergoing level three axillary node clearance were studied to ascertain the benefit of collar and cuff shoulder immobilization in reducing the incidence of axillary seroma formation . During this period the patients ' views were obtained on this aspect of post-operative care . Although daily drainage volume decreased more rapidly in those patients whose shoulders were immobilized this did not result in a significant decrease in seroma formation following drain removal on the fifth post-operative day ( 31 % vs 43 % , P>0.05 ) . Patient interviews revealed that they found the collar and cuff incapacitating , felt it delayed their return to normal activity and made personal hygiene difficult to maintain . In view of these results shoulder immobilization should not be employed in the routine post-operative care of these patients BACKGROUND AND METHODS The influence of negative pressure on fluid production and complication rates after axillary dissection for breast cancer was studied in a prospect i ve r and omized trial . Patients were r and omized for either a high or a low vacuum drainage system .  Drainage volumes and complication rates were recorded . RESULTS No statistically significant differences were found between the low vacuum group ( n = 68 ) and the high vacuum group ( n = 73 ) in volume ( 728 ml versus 780 ml ) and duration ( 9.5 days versus 10 days ) of seroma production , number of wound complications ( 5 versus 6 ) , or infections ( 3 versus 2 ) . There was a significant positive relationship between body mass index and seroma production , independent of the drainage system ( P = 0.002 ) . The drainage volume of the separately drained breast wound after mastectomy and lumpectomy was larger for the high vacuum system ( 55 ml versus 100 ml , P = 0.02 ) . Vacuum loss was more frequent in the high vacuum drain group ( 11 versus 2 , P = 0.01 ) , where as leakage around the drain occurred more often in the low vacuum group ( 18 versus 6 , P = 0.004 ) . CONCLUSION There are no differences in axillary fluid production or wound complication rates after axillary dissection and subsequent drainage between high and low vacuum drainage systems BACKGROUND Electrocautery has been postulated as a factor in the risk of seroma formation after mastectomy . METHODS Eighty consecutive mastectomies in 74 patients were r and omly assigned to dissection of the mastectomy flaps with either scalpel ( n = 38 ) or electrocautery ( n = 42 ) . Total volume of fluid output through drains and aspirated from seromas was recorded . Other factors investigated included the type of drain utilized , estimated blood loss , and complications . RESULTS Seromas developed in 16 wounds in the electrocautery group compared with 5 in the scalpel group ( 38 % and 13 % , respectively ; P = 0.01 ) . Other factors with an independent risk for seroma included use of Jackson-Pratt drains compared with Blake drains ( P = 0.006 ) , and lower estimated blood loss ( P = 0.006 ) . No differences in characteristics of patients or in other complications were noted . CONCLUSIONS Use of electrocautery to create skin flaps in mastectomy reduced blood loss but increased the rate of seroma formation Abstract Background : Seromas and impaired shoulder function are well-known complications after modified radical mastectomy for breast cancer . Early postoperative physiotherapy is a common treatment to avoid shoulder dysfunction . The aim of this study was to evaluate if the frequency of postoperative seromas could be reduced , without increasing shoulder dysfunction , by delayed postoperative shoulder exercises . Methods : In a prospect i ve study 163 patients with breast cancer undergoing modified radical mastectomy  were r and omized to physiotherapy starting on postoperative day 1 or day 7 . Patients were seen by the surgeons and the physiotherapists during hospital stay and in the outpatient department . Seromas and other complications were registered by the surgeons . The physiotherapists instructed the patients pre- and postoperatively and assessed shoulder function . Results : There was a significantly higher incidence of postoperative seromas in the group of patients that started physiotherapy postoperative day 1 ( 38 % ) compared to the group that started physiotherapy postoperative day 7 ( 22 % ) ( p<0.05 ) . There was no significant difference between the groups in the late outcome of shoulder function . Conclusion : The incidence of seromas after modified radical mastectomy for breast cancer is reduced by delaying shoulder exercises one week postoperatively . Earlier postoperative physiotherapy is not necessary to avoid impaired shoulder function BACKGROUND This study was design ed to determine the effectiveness of Hemaseel APR fibrin sealant versus conventional drain placement in the prevention of seromas after breast procedures . METHODS A prospect i ve , r and omized , controlled study of subjects who were r and omized into control ( drain ) and experimental ( fibrin ) groups was conducted . RESULTS Analysis of 82 patients showed similarly matched groups . Seroma formation rate was 45.5 % in the control group and 36.8 % in the fibrin glue group ( P = 0.43 ) . The rate of wound complications was similar . Aspirate volumes were significantly greater in the fibrin glue group . Drain placement saved patients > 366 US dollars over fibrin glue . CONCLUSIONS Although use of fibrin sealant result ed in a nonsignificant decrease in seroma formation rate compared with that of drain placement , the higher cost involved , cumbersome technique , and higher aspirate volumes tend to indicate that there is no advantage to using fibrin glue over drain placement with the technique described BACKGROUND To reduce the risk of seroma after modified radical mastectomy in breast cancer patients , the use of suction axillary drainage is a st and ard procedure . The optimal time to remove the drain is not established . Whether the removal or preservation of the pectoral fascia influences the risk of seroma formation or loco-regional recurrence rate remains unclear . METHOD The trial included 247 patients with breast cancer who underwent modified radical mastectomy in five Swedish hospitals 1993 - 1997 . The median follow-up time was 6 years . One hundred and twenty-two and 125 patients , respectively , were r and omised between removal versus preservation of the pectoral fascia . Of these 247 patients a total of 198 patients were also r and omised to have the drain removed 24 h postoperatively or to keep the drain in until discharge had decreased to less than 40 ml/24 h. RESULTS Early removal of the axillary drain was associated with significantly more seromas and a shorter average postoperative hospital stay . There were no differences between the two groups regarding the rate of wound infections and /or hematoma formation . Removal or preservation of the pectoral fascia did not influence the formation of seroma or the amount of peroperative bleeding . A trend towards an increased risk for chest wall recurrence was observed in patients with preserved pectoral fascia ( 16/125 compared with 8/122 ; hazard ratio=2.0 , 95 % confidence interval=0.9 - 4.7 ) . CONCLUSION Early removal of axillary drain shortened the duration of hospital stay without any increase in wound complications . However , it yielded a significantly higher incidence of seroma . Seroma formation and the chest wall recurrence rate was not significantly influenced by the preservation of the pectoral fascia or not The influence of primary systemic therapy in treating operable breast cancer on postmastectomy morbidity rates was investigated . The contribution of other risk factors was assessed by multiple logistic regression . Seventy‐nine eligible patients were r and omly allocated , 39 to undergo immediate modified radical mastectomy , and 40 to receive initial cytotoxic or endocrine treatment followed by mastectomy .  Postoperative wound seroma , infection and necrosis were recorded prospect ively . Fourteen minor and six major complications occurred in 17 patients treated conventionally , while 14 patients developed 11 minor and six major complications after systemic therapy ( P > 0·4 ) . Median hospital stay was 8 days for both groups . Age , smoking , immediate breast reconstruction and the type of primary systemic treatment given were not independent predictors of complication risk . Obesity emerged as a significant risk factor for postmastectomy complications ( P = 0·015 ) . Primary systemic therapy does not increase the rate of morbidity after mastectomy Fibrin as a tissue sealant has been used since the turn of the century for hemostasis . The development of cryoprecipitate and the result ant availability of higher concentrations of fibrinogen have led to a resurgence of interest in this material . Fibrin glue has since been shown to be effective for numerous applications throughout the field of surgery . Animal studies have shown fibrin glue to be effective at reducing drain output after mastectomy . Human studies , however , have been equivocal . Our objectives were to determine whether the use of fibrin glue would decrease lymphatic drainage after modified radical mastectomy and subsequently reduce time to drain removal . A prospect i ve r and omized trial was conducted consisting of 27 women . All women received modified radical mastectomy .  At the completion of the mastectomy they were r and omized to receive either st and ard closure or the application of fibrin glue before st and ard closure . Patients were then monitored for daily drain output , time to drain removal , and wound complications . A total of 14 women received fibrin glue  and 13 received  no glue . Those patients receiving fibrin glue had a significantly higher average drain output than patients who did not receive glue ( 1308 vs 754 cm3 ; P = 0.012 ) . Time to drain removal was also increased by 4 days , although this did not reach statistical significance . The overall complication rate was higher for the fibrin glue group , although again , this did not reach significance . The application of fibrin glue significantly increased drain total drain output after modified radical mastectomy . Time to drain removal was increased as was the complication rate . On the basis of these data fibrin glue can not be recommended for routine use in modified radical mastectomy Initial attempts to obliterate dead space and minimize fluid accumulation in patients after mastectomy using closed suction drainage  , used insertion of a single axillary drain . Today , surgeons often insert two drains in the postoperative wound , one in the axilla and the other beneath the pectoral flaps . The current study was done to determine whether or not there is an advantage in using two drains rather than a single axillary drain after mastectomy . A r and omized , clinical trial was conducted with 84 women undergoing modified radical mastectomy . Thirty-seven patients had one  axillary drain  and 47 had  two drains placed postoperatively , one in the axilla and the other beneath the pectoral flaps . Follow-up results were obtained four weeks postoperatively for complication data , including seroma and hematoma formation , flap necrosis and infection . The average total drainage was 870.4 milliliters per patient in the group with one drain and 997.4 milliliters per patient in the group with two drains ( p value not significant ) . The overall complication rate in the group with one drain was 35.0 percent compared with a rate of 31.9 percent for all complications observed in the group with two drains . These differences did not reach statistical significance . Comparing the frequency of each complication in the two groups again showed no significant difference . However , the data suggest a trend toward an increased incidence of flap necrosis in the group with two drains that used a drain beneath the pectoral flaps . Use of a single axillary drain after modified radical mastectomy seems to result in no increase in postoperative complications , is less costly and may assist in reducing the incidence of flap necrosis Serosanguinous drainage after mastectomy and axillary lymph node dissection has traditionally been treated with the temporary use of closed suction drainage catheters . Use of drainage catheters is associated with wound infection , discomfort , nerve injury , and impaired arm movement . Commercially produced fibrin sealant has been proposed to reduce postoperative serosanguinous collection s. We hypothesized that the intraoperative application of low-dose ( 2 - 5 cm3 ) fibrin sealant would reduce serosanguinous drainage and allow earlier removal of closed suction drainage catheters after operation for breast cancer . Fifty-five women with known breast cancer underwent either total mastectomy , modified radical mastectomy , or isolated level I and II axillary lymph node dissection . Twenty-six patients were treated with fibrin sealant and 29 served as control subjects . The application of fibr 
    Output:
    
On the other h and , the following factors did not have a significant influence on seroma formation : duration of drainage ; hormone receptor status ; immobilization of the shoulder ; intensity of negative suction pressure ; lymph node status or lymph node positivity ; number of drains ; number of removed lymph nodes ; previous biopsy ; removal of drains on the fifth postoperative day versus when daily drainage volume fell to minimal ; stage ; type of drainage  ( closed suction versus static drainage ) ; and use of fibrinolysis inhibitor .
In contrast , sentinel lymph node biopsy reduced seroma formation .
Evidence was weak , or unproven , for other factors that were commonly cited in the literature .
Although a number of factors have been correlated with seroma formation , strong evidence is still scarce .
However , there is evidence showing that sentinel lymph node biopsy reduces seroma formation