Electrocautery as a factor in seroma formation following mastectomy

Background: Electrocautery has been postulated as a factor in the risk of seroma formation after mastectomy. Methods: Eighty consecutive mastectomies in 74 patients were randomly 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.