***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: We assessed whether axillary dissection using the electrothermal bipolar vessel sealing system ( LigaSure ) improved perioperative outcome when compared with conventional axillary dissection , in a prospect i ve r and omized study of 100 women with breast cancer . Those needing axillary dissection were r and omized to the use of LigaSure or to conventional axillary dissection ( with 50 patients in each group , all of whom had a closed suction drain in the axilla ) . The LigaSure patients had less intraoperative blood loss ( exceeding 199 mL in 30.8 % vs. 69.2 % , P < 0.001 ) , quicker axillary dissection ( mean 48 vs. 63.2 min , P = 0.004 ) , fewer days of suction drainage ( 4.3 vs. 5.7 days , P = 0.012 ) , and shorter hospitalization ( 5.1 vs. 6.5 days , P = 0.021 ) . No difference was found in the rate of hematomas , reoperations or infection . The use of LigaSure in axillary surgery reduced the surgical time and length of hospital stay , favoring early drain removal without increasing postoperative complications 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 Surgical site infection ( SSI )  after breast procedures may result in significant morbidity , psychologic trauma , and additional cost , SSI rates in patients at the Clevel and Clinic Foundation having biopsy , partial mastectomy , or modified radical mastectomy were higher during April and May 1995 than during the previous 12 months ( 8 infections for 74 procedures [ 10.8 % ] vs 10 for 378 [ 2.6 % ] ; p < 0.006 ) . Since 1993 one surgeon has performed most of these procedures , with no change in operative technique , skin preparation , or surgical team . A case-control study was performed to identify risk factors for infection . METHODS A case patient was defined as any patient having a breast procedure from April 1994 through May 1995 with culture of a pathogen from surgical site drainage or aspiration or with erythema or presence of cellulitis treated by incision and drainage and /or antibiotic therapy . R and omly selected control patients were matched by time and procedure . There were 18 case patients and 37 control patients . RESULTS Factors associated with SSI were obesity ( 78 % of cases vs 40 % of controls ; p = 0.02 ) and older age ( mean 66 years in cases vs 56 years in controls ; p = 0.005 ) . After introduction of cefazolin sodium prophylaxis , SSI rate was reduced to 0.9 % ( 3 infections for 332 procedures ) . CONCLUSIONS Host factors may contribute to SSI in breast procedures . Cefazolin sodium prophylaxis was useful in preventing SSI after breast surgery Neoadjuvant chemotherapy is the st and ard of care for patients with large , inoperable tumors or inflammatory breast cancer , but it is also increasingly considered for women with operable disease . Several r and omized trials have demonstrated that anthracycline- and taxane-containing regimens in operable breast cancer were equally effective in terms of disease-free or overall survival regardless of whether they were administered postoperatively or preoperatively . Further neoadjuvant treatment allows for a higher rate of breast conserving surgery . Tumor responses in terms of pathologic complete remission after short-term chemotherapy will probably only serve as a surrogate marker for long-term outcome in some molecular breast cancer subtypes like the triplenegative , HER2-positive , and some luminal B subsets . Recent trials showed that in HER2-positive disease pCR rates were as high as 70 % when 2 HER2-targeted agents were added to chemotherapy HYPOTHESIS The use of the electrothermal bipolar vessel sealing system is feasible , safe , and effective in modified radical mastectomy with axillary dissection in terms of lymph vessel sealing , hemostasis , and perioperative complications . DESIGN Prospect i ve study . SETTING University surgical department . PATIENTS Between January 1 , 2003 , and December 31 , 2003 , 60 patients with locally advanced breast cancer ( T2 or T3 ) admitted for modified radical mastectomy with axillary dissection were included in this study . The entire procedure was performed by the same surgical team using the electrothermal bipolar vessel sealing system . MAIN OUTCOME MEASURES Final outcome , operative time , hospitalization stay duration , intraoperative blood loss , postoperative mastectomy and axillary drainage volume and duration , and postoperative complications ( seroma , bleeding , skin burn , hematoma , lymphedema , pneumothorax , and wound infection or necrosis ) . RESULTS The mean ( SD ) intraoperative blood loss was 45 ( 12 ) mL , and the mean ( SD ) operative time was 105 ( 7 ) minutes . No postoperative bleeding , seroma , hematoma , lymphedema , or other complications occurred . The mean ( SD ) mastectomy and axillary drainage volumes were 20 ( 8) and 155 ( 35 ) mL , respectively , and the mean ( SD ) drainage duration s were 1.3 ( 0.2 ) and 2.7 ( 0.5 ) days , respectively . The mean ( SD ) hospital stay was 3.7 ( 0.6 ) days . CONCLUSIONS In this first report ( to our knowledge ) of modified radical mastectomy with axillary dissection using the electrothermal bipolar vessel sealing system , the technique was feasible , safe , and effective . The device simplified the surgical procedure , while achieving efficient lymph vessel sealing and hemostasis . Compared with historical data regarding the conventional or harmonic scalpel , this technique seems to result in reduced operative time , perioperative blood loss , drainage volume and duration , and incidence of seroma or lymphedema . Prospect i ve r and omized controlled studies are necessary to evaluate the effect of this technique on perioperative complications AIM To compare safety and efficacy of a bipolar vessel sealing system ( BVSS ) to the conventional technique in axillary node dissection . METHODS 116 women with breast cancer were r and omized to conventional node dissection surgical technique ( control ; n = 58 ) by scalpel and monopolar cautery or using an electrothermal BVSS ( study group ; n = 58 ) . RESULTS The median ( range ) total volume of fluid collected by drain and aspirations was 305 ( 30 - 1420 ) mL in the study group and 335 ( 80 - 1070 ) mL in the control group ( p = 0.325 ) . The median ( range ) total volume of lymph collected by percutaneous aspirations was 207.5 ( 40 - 1050 ) mL in the study group and 505 ( 270 - 705 ) mL in the control group ( p = 0.010 ) . The incidence of seroma was similar in both groups ( p = 0.845 ) . The axillary drain was removed earlier in the study group than in controls ( p = 0.046 ) . CONCLUSION The use of a BVSS offers marginal advantages when compared to the conventional technique One hundred and seven bilateral breast reductions were prospect ively r and omised during surgery to receive or not receive wound drains . Fifty-five patients were r and omised to have a drain and 52 to not have a drain . There was no statistical difference in the number of complications between the drained and undrained group ( P=0.092 ; student 's t-test for independent observations ) . Twenty-two of the 55 patients in the drained group had a complication , 12 of the 52 patients in the undrained group had a complication . The hospital stay was significantly shorter ( P<0.001 ) in the undrained group . The main discomfort score due to the presence of the drains was 5.62 , which can be qualified as high . This study demonstrates that breast reduction without postoperative draining does not increase the risk of complications , increases the patient 's comfort and significantly reduces hospital stay Increasing duration and amount of postoperative fluid formation after axillary lymphadenectomy delays final healing . We postulated that multiple drains ( instead of a single drain ) might decrease postoperative fluid accumulation by their greater proximity to points of leakage . We r and omized 65 women with clinical stage I or II carcinoma of the breast to single or multiple drains . They were stratified for axillary dissection or modified radical mastectomy . For axillary dissection , r and omization to multiple drains meant placement of four catheters in the axilla , and r and omized to the single drain , one catheter in the axilla . For modified radical mastectomy , the patients r and omized to multiple drains received four catheters in the axilla and one catheter under the inferior flap ; the patients r and omized to single drains had one catheter in the axilla and one catheter under the inferior flap . All catheters exited separately . The two arms ( single versus multiple drains ) were determined to be homogeneous in other variables that may affect postoperative fluid formation -- age , size of the breast , weight , height , obesity , presence of previous surgical biopsy , excision of pectoralis minor muscle , excision of thoracodorsal complex , level of axillary dissection , number of lymph nodes , number and proportion of positive lymph nodes and whether or not the dominant h and was on the side operated upon . Single versus multiple drains had no clinical ly significant effect on the amount or duration of drainage , as an inpatient or outpatient , or total . We recommend a single drain to the axilla after lymphadenectomy Background Prolonged and excessive drainage of serous fluid and seroma formation constitute the most common complications after mastectomy for breast carcinoma . Seroma formation delays wound healing , increases susceptibility to infection , skin flap necrosis , persistent pain and prolongs convalescence . For this , several techniques have been investigated to improve primary healing and minimize seroma formation . Material s and methods Between June 2009 and July 2010 forty patients with breast carcinoma , scheduled for modified radical mastectomy , were r and omly divided into 2 groups , the study group ( 20 ) and the control group ( 20 ) . In the study group ; the mastectomy flaps were fixed to the underlying muscles in raws , at various parts of the flap and at the wound edge using fine absorbable sutures . In the control group ; the wound was closed in the conventional method at the edges . Closed suction drains were used in both groups . Patients , tumor characteristics and operative related factors were recorded . The amount and color of drained fluid were recorded daily . The drains were removed when the amount become less than 50 cc . The total amount and duration of drained fluid and the formation of seroma were recorded and the results were compared between the two groups . Results In the flap fixation group , the drain was removed in significantly shorter time compared to the control group ( p < 0.001 ) . Also , the total amount of fluid drained was significantly lower in the flap fixation group ( p < 0.001 ) . The flap fixation group showed a significantly lower frequency of seroma formation compared to the control group , both clinical ly ( p = 0.028 ) and ultrasonographically ( p = 0.047 ) . Conclusions The mastectomy flap fixation technique is a valuable procedure that significantly decreases the incidence of seroma formation , and reduces the duration and amount of drained fluid . However , it should be tried on a much wider scale to prove its validity Background : After lymphadenectomy for early breast cancer , seroma formation is a constant event requiring a suction drainage . This drainage is the strongest obstacle to reducing the hospital stay .  Axillary padding without drainage appears to be a valuable option amid the various solutions for reducing the hospital stay . Methods : We conducted a comparison between 114 patients with padding and 185 patients with drainage .  Data were obtained from 2 successive prospect i ve studies . Results : The mean hospital stay was 2.4 days ( range 1–4 ) in the padding group and 4.2 days ( range 2–9 ) in the drainage group ( p < 0.05 ) . There were fewer needle aspirations for seroma in the padding 
    Output:
    
The current review s conclude that insertion of a drain is associated with a longer hospital stay and reduced seroma formation .
The data regarding wound infection and drain insertion is inconclusive .
The omission of a drain is associated with early discharge , reduced postsurgical pain , and early mobilization , but also with an increase in out-patient seroma aspirations .