Current use of drains and management of seroma following mastectomy and axillary surgery: results of a United Kingdom national practice survey
Authors: Fairhurst K. , Roberts K. , Fairbrother P. , Potter S. ,   on behalf of the Diamond Study Collaborative, Abbott Nick , Achuthan Raj , Ahmed Goran , Ainsworth Rachel , Arthur Laura , Bains Salena , Barber Zoe , Batt Jeremy , Bell Ashleigh , Carter Jane , Chambers Alice , Conway Anna , Courtney Carol-Ann , Daltrey Ian , Daoud Raouf , Dash Isabella , Dave Rajiv , Dicks Julia , Donigiewicz Urszula , Fatayer Hiba , Glassman Daniel , Green Nikki , Gutteridge Eleanor , Hamad Ahmed , Hargreaves Anita , Harvey James , Hassan Ali Shaziya , Helme Sophie , Henderson Julia , Hignett Susan , Hoar Fiona , Horsnell Jonathan , Hubbard Thomas , Humphreys Alex , Iqbal Javeria , Johnson Omotayo , Joshi Meera , Kallaway Charlotte , Karat Isabella , Kim Baek , Kleidi Eleftheria , Kothari Manish , Laban Chrissie , Lambert Kelly , Laws Siobhan , Leeper Alexander , Ledwidge Serena , Lefemine Valentina , Lund Jonathan , Jane Macaskill E , Malik Mariam , Mansell James , Maraqa Loaie , Masannat Yazan , Massey Julia , McLean Ross , McIlhenny Jennifer , Mcllmunn Colin , Merker Louise , Mitchell Geraldine , Mondani Jo , Morrow Elizabeth , Nasir Nabila , Odofin Olubunmi , Osborne Caroline , Partlett Polly , Powell-Chandler Anna , Sundara Rajan Sreekumar , Rogers Clare , Roshanlall Chandeena , Philip Rowland Matthew , Abou Samra Walid , Satherley Lucy , Skelly Brendan , Sutton Richard , Tansley Anne , Konstantinos Tasoulis Marios , Timbrel Simon , Touqan Nader , Waterworth Alison , Whisker Lisa , Williams Kate , Gonen Yildirim Nihal , Zammit Charles 
Published: October 2023

Abstract
Purpose
Up to 40% of the 56,000 women diagnosed with breast cancer each year in the UK undergo mastectomy. Seroma formation following surgery is common, may delay wound healing, and be uncomfortable or delay the start of adjuvant treatment. Multiple strategies to reduce seroma formation include surgical drains, flap fixation and external compression exist but evidence to support best practice is lacking. We aimed to survey UK breast surgeons to determine current practice to inform the feasibility of undertaking a future trial.

Methods
An online survey was developed and circulated to UK breast surgeons via professional and trainee associations and social media to explore current attitudes to drain use and management of post-operative seroma. Simple descriptive statistics were used to summarise the results.

Results
The majority of surgeons (82/97, 85%) reported using drains either routinely (38, 39%) or in certain circumstances (44, 45%). Other methods for reducing seroma such as flap fixation were less commonly used. Wide variation was reported in the assessment and management of post-operative seromas. Over half (47/91, 52%) of respondents felt there was some uncertainty about drain use after mastectomy and axillary surgery and two-thirds (59/91, 65%) felt that a trial evaluating the use of drains vs no drains after simple breast cancer surgery was needed.

Conclusions
There is a need for a large-scale UK-based RCT to determine if, when and in whom drains are necessary following mastectomy and axillary surgery. This work will inform the design and conduct of a future trial.