Are Fibrin Sealants Effective in Decreasing Seroma Formation in Reduction Mammoplasty? A Single-Surgeonís Experience
Kailash Kapadia, MD, Jocellie Marquez, MD, Kanad Ghosh, BA, Gurtej Singh, PhD, Tara Huston, MD.
Stony Brook University Hospital, Stony Brook, NY, USA.
Background: Fibrin sealant is controversial method for reducing seroma formation. Comprised of human pro-clotting factors fibrinogen and thrombin, it is commonly used in autologous breast reconstructions. However, according to the U.S. Food and Drug Administration, fibrin sealant carries the risk of fluid stasis due to blockage of drainage tubes, hypersensitivity reactions, the transmission of infectious viruses and neurodegenerative diseases. In fact, some formulations contain a neurotoxin and is contraindicated in neurosurgery. Despite these concerns, many plastic surgeons use such products in ambulatory surgeries even though its efficacy on seroma prevention has yet to be elucidated. The aim of our study is to determine whether fibrin sealant is effective in decreasing seroma formation in reduction mammoplasty. Methods: A retrospective chart review was performed of all bilateral reduction mammaplasty by a single-surgeon from 2000-2018. Pre-operative demographic and operative risk factors were collected. Operative notes were reviewed for whether fibrin sealant was used. Post-operative data will be reviewed for complications up to 90-days post-operative. Exclusion criteria consisted of patients <18 years of age, history of prior breast surgeries or incidental cancer diagnosis in breast reduction tissue specimen. Statistical analyses were performed to identify potential confounding factors. Results: On analysis, 159 patients met inclusion criteria. One-hundred and one patients (63.5%) underwent reduction mammaplasty where fibrin sealants (Group 1) were utilized, 58 (36.5%) patients did not receive fibrin sealant (Group 2). Outcomes for Tisseal, floseal and Evicel were recorded. There were no significant differences between those who developed seromas compared to those who did not within Group 1 (20.7% vs. 79.2%, p=0.8397), respectively. Similar trends were observed in Group 2 (18.9% vs. 46.5%, p=0.8397). The use of sealant alone was more likely to result in seroma formation compared to the combination of sealant with suction drains (25% vs 8%, p=0.09), which approached significance. Conclusion: Our data does not support the use of fibrin sealant as a solo method for preventing seroma formation in patients undergoing reduction mammaplasty. It may reduce the magnitude of seromas when used in combination with suction drains. Regardless, plastic surgeons should consider weighing the risk versus benefits before using fibrin sealant in ambulatory surgeries.
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