A comprehensive study on the effect of injection methylprednisolone in post mastectomy seroma

Background: Seroma formation is a common problem after mastectomy. The incidence varies between 30% to 92%. It is often an ongoing problem after removal of the suction drain, and repeated skin puncture is necessary to remove the seroma. In addition to many ambulatory visits this also leads to an increased risk of infection, and the adjuvant treatment can be delayed for several weeks. Different procedures have been tried to avoid seroma formation. Among these are for examples: immobilisation of the arm and shoulder after mastectomy, different drain regimens, closing of the dead space of the cavity, different chemical substances as thrombin, tranexamacid and fibrin. None of these results has been successful. Seroma formation is most likely the result of the inflammatory response due to wound healing. In the seroma fluid several factors have been detected that support this assumption. These factors are: high levels of IgG, leucocytes, granulocytes, proteinases, proteinases inhibitors, different kinds of cytokines (tPA, uPA,, uPAR, PAI-1, PAI-2, IL-6 og IL-1). On the basis of this, an inhibition of the inflammatory response might result in a decrease of seroma formation, and perhaps improve quality of life after mastectomy. Steroids inhibit the inflammatory response for example by inhibition of the cytokine function. It has been shown that a high single dose of steroid infusion (30 mg/kg solu-medrol) inhibits the normal IL 6 response after colon resection. Newer studies have shown that even at a lower dose the inflammatory response is inhibited. In several studies of head and neck surgery the oedema in surgical area is reduced after a single dose of 125 mg solumedrol. It is precisely this effect of reduced fluid formation we want to obtain in our study. We have therefore chosen to use a single dose of 125 mg of solumedrol in this study. Even at the largest single dose of glucocorticoids there have not been seen any increasing in surgical complications. Aim: The aim of this study was to study the effect of injection methylprednisolone in post mastectomy seroma in patients coming to Govt. Villupuram Hospital. Materials and methods: This was a prospective study consisting of 20 patients diagnosed as carcinoma breast who underwent modified radical mastectomy in our institution. With all aseptic precautions, 125 mg methylprednisolone sodium succinate intravenously as a single bolus before the start of surgery in patients undergoing modified radical mastectomy in case group. Results: Most common age group was 41-50 years of age. In 2 cases seroma aspiration was present. Conclusion: Since Seroma formation is the most common complication of Mastectomy and among the methods used to reduce its incidence, steroid administration seems to be the most cost effective and shows promising results. Its routine use in every case is recommended under good antibiotic cover and wound care.