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American Journal of  
Chemistry and Pharmacy (AJCP)

Seroma Formation after Mastectomy with or without Thoracoabdominal 
Binder – A Randomized Control Trial

Maryam Essa Alfard1*, Shereya Devendra2

Volume 2 Issue 2, Year 2022
ISSN: 2834-0116 (Online)

DOI: https://doi.org/10.54536/ajcp.v2i2.1540
https://journals.e-palli.com/home/index.php/ajcp

Article Information ABSTRACT

Received: April 10, 2023

Accepted: May 01, 2023

Published: May 16, 2023

The study’s main objective is to reduce seroma production post-mastectomy with the help of  
using thoracoabdominal binders. The randomized controlled trial (RCT) included patients 
(No=40) that received breast surgery. They were divided into two groups; the control group 
(No=20) was the one that did Not use the binders, and the study group (No=20), complied 
with adorning the thoracoabdominal binder for two weeks post-breast surgery. The drainage 
of  both breasts and axillary drains was examined during this duration. The amount of  
drainage was Noted, and charts were created on that basis. A total of  40 patients initially 
became a part of  this trial, equally divided into two groups of  20 patients each. All of  the 
participants of  this group had undergone breast surgery (either mastectomy or MRM) and 
had to appear for the follow-up examination 2-3 weeks post-surgery. In these follow-up 
meetings in the outpatient clinic, the drainage charts were maintained, including the levels 
of  drain output and compliance rate of  the thoracoabdominal binder group; some patients 
were excluded from the study due to exclusion criteria.There was No difference between 
both groups in the drainage output, thus imposing No major impact of  thoracoabdominal 
binders on seroma reduction. Other implications of  binders in breast care post-surgery were 
explored to add to the positive effects of  binders. This suggests that more studies need to be 
done to find the best management methods for postoperative seroma formation.

Keywords
Breast Care, Drainage, 
Mastectomy, Seroma, 
Thoracoabdominal Binders

1 Specialized Surgeon, Dubai Hospital, United Arab Emirates
2  222, Al Khaleej St - Deira, Dubai, United Arab Emirates
* Corresponding author’s e-mail: maryamessa23alfard@outlook.com

INTRODUCTION
Breast cancer these Days addresses the most widely 
recognized cancer among ladies, with more than 2 million 
new cases in 2018. Its careful treatment depends on 
oncoplastic medical procedure, a combination of  those 
two disciplines with the last objective of  a result adjusted 
between the best oncologic and therapeutic outcomes. 
Without a doubt, since its origination, breast remaking has 
assisted patients with looking “typical” when dressed; all 
the more, as of  late, progressions in careful procedures 
and clinical advancements have increased present 
expectations so patients can feel tastefully satisfied and 
likewise unclothed (Salgarello, 2012). During the many 
previous years, the straightforward way to deal with breast 
cancer has developed from extremist mastectomy to the 
improvement of  breast‐conserving medical procedures 
and reconstructive strategies. After an areola or skin‐
sparing mastectomy, the chance of  having played out a 
prompt remaking addresses an extraordinary benefit for 
patients, inferable from its critical psychosocial benefits. 
As of  Now, quick implant‐based breast remaking (IBR) 
addresses 81.9% of  all breast reconstructive strategies 
(Masià et al., 2020).
Axillary lymphadenectomy (ALN) remains the standard 
choice in many cases of  breast tumors. Likewise, to agony, 
hematoma and contamination, the fundamental early 
unfavorable impact of  ALN is the post-usable creation 
of  liquid in the axillary bowl. Seroma development is 
a consistent component; however, the volume has a 
wide variety. Subsequently, the pace of  symptomatic 
seromas that require needle yearning goes from 20 to 

60% (Kopelman et al., 1999). Seroma is defined as the 
clear fluid deposited under the primary layer of  the skin, 
which is usually found near the incision site after surgery, 
typically of  reconstructive type (Pogson et al., 2003). This 
occurs because space is created in such surgical procedures 
due to tissue removal. Seroma is a typical post-surgery 
complication in breast cancer. It is considered a common 
cause of  discomfort and irritation in patients, which might 
result in extending the hospital stay. It can cause problems 
like an infection on the site of  surgery, slow laceration 
healing, and mortification of  the skin flap. Substantial 
research is being carried out to comprehend the etiology to 
uncover different means of  reduction of  seroma formation 
(de Rooij et al., 2020).

LITERATURE REVIEW
Countless RCTs are being established to reduce 
complications created by seroma formation. Many studies 
give a mixed opinion over the insertion of  drainage post-
surgery as a method of  seroma reduction. Florian et al. 
(Ebner et al., 2014) explain that the most common reasons 
for the introduction of  a drain in breast cancer surgery are: 
(i) reducing the risk of  a possible hematoma, (ii) drainage of  
the seroma of  the incision, or (iii) controlling the infections 
occurring at the surgical site. It has also been stated that 
Not including a drain might have the following side effects: 
a larger amount of  seroma-related complications. Other 
risk factors like the size of  the breasts, age, number of  
lymph Nodes with tumors and blood pressure have also 
been examined in the past years (Droeser et al., 2009; 
Srivastava et al., 2012).

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Drain
Using a drain has been a typical practice to demolish the 
dead space made after a medical procedure. The utilization 
of  closed suction drainage in patients who went through 
mastectomy speeds up injury recuperating and is likewise 
connected with a lower occurrence of  wound contamination, 
necrosis, and breakdown (Srivastava et al., 2012). Research 
by Bourke et al (Bourke et al., 1976) found No distinction 
between utilizing closed suction and creased wound 
drainage in 51 patients who underwent straightforward 
mastectomy (Thoren, 1964). In a concentrate by Whitfield 
and Rainsbury (Whitfield & Rainsbury, 1994), No huge 
contrast was seen between suctioned and closed siphon 
drainage on seroma development. The amount of  quantity 
of  drain tubes used has been researched. Two randomized 
trials reported that using different drainage tubes presents 
No critical benefit on the sum or length of  seroma seepage 
(Petrek et al., 1992; Terrell & Singer, 1992).

Thoracoabdominal Binders
A thoracoabdominal binder is a wide belt encompassing 
the thorax and abdomen and supporting the incision. 
Binders have been around for quite a while, yet their 
significance has fluctuated over the long run; there has 
forever been disagreement concerning whether they were 
great for patients or useless. Accordingly, we led the current 
randomized controlled trial to explore the clinical impacts 
of  thoracoabdominal binders. We plan to give proof-
based ideas to its expected in postoperative consideration 
for breast surgeries (Jiang et al., 2021). Stomach versatile 
folios (trusses, girdles, stomach belts, longuette, and so 
forth) (Cheifetz et al., 2010; Fagevik Olsén et al., 2009; 
Christopher M Larson et al., 2009) are often utilized 
regularly after laparotomy and ventral hernia fix. The 
beneficial impacts incorporate, among others, relief  from 
discomfort, decreased chance of  seroma development, 
worked on respiratory capability and postural strength. 
In any case, using abdominal binders depends on unclear or 
No proof. Besides, the clinical impacts of  stomach covers 
have been tested because of  an expected gamble of  post-
usable pneumonic inconveniences (Rothman et al., 1966). 
On the positive side, documentation from a couple of  
studies infers that stomach fasteners reduce postoperative 
torment, seroma development, mental distress, and 
postoperative uneasiness (P. Chowbey et al., 2000; Jin et 
al., 2009; Christopher M Larson et al., 2009; K. LeBlanc, 
2004). Abdominal binders have likewise been shown to 
upgrade activation, safeguard the patient’s injury, help in 
coughing, and ease deep breathing (Rothman et al., 1966). 
Lymphedema is a well-kNown condition occurring right 
after breast surgery, but No agreement has been reached 
about the best treatment course. Careful methodologies, 
despite, are getting expanded consideration. Different 
microsurgical reconstructive procedures plan to reestablish 
life structures and capability of  the lymphatic framework 
in upper limb breast cancer-related lymphedema (BCRL) 
(Masia et al., 2016). 
Since the lymphatic system is a complex vascular system, 

we concentrate on its life systems and usefulness in 
every individual patient utilizing symptomatic imaging 
strategies: lymphoscintigraphy, figured tomography 
angiography (CTA), indocyanine green (ICG) backhanded 
lymphography, and magnetic resonance (MR)-
lymphography. A preoperative limb lymphoscintigraphy 
is performed for every patient to evaluate the lymphatic 
capability of  the limb.

MATERIALS & METHODS
Study Design
This is a Randomized Controlled Trial (RCT) based on 
exploring the effectiveness of  using thoracoabdominal 
binders in seroma reduction post-mastectomy. The Dubai 
Hospital Ethical Committee examined and approved the 
study procedure. All participants provided their consent in 
writing after being fully informed. The participants’ privacy 
was protected throughout the study, and the confidentiality 
of  the data acquired was guaranteed.The patients who 
consented to participate in this study were allotted to one 
of  the two groups: the thoracoabdominal group, where 
patients adorned binders post-surgery. At the same time, 
the other was the control group (without binders). Both 
groups were carefully observed to compare the seroma 
drainage amount and other complications (if  any).

Setting and Patient Selection 
Patients were selected from three different Saudia Arabia 
regions: central, Northern and southern. Patients who had 
received breast surgeries such as mastectomy or modified 
radical mastectomy (MRM) because of  invasive breast 
cancer or ductal carciNoma in situ (DCIS) were qualified 
for consideration in the present trial. Patients undergoing 
a breast-enlargement procedure or primary breast 
reconstructive treatments were barred.

Interim Analysis
The interim analysis for this seroma reduction after MRM 
or mastectomy trial was initially conducted to identify the 
effectiveness of  thoracoabdominal binders. None of  the 
postoperative methods seemed superior to discontinuing 
the rest of  the practice at that particular interval. 

Randomization
According to a PC-created randomization plan, patients 
will be arbitrarily allocated to one of  the two bunches 
with a 1:1 distribution. Randomization will occur upon the 
arrival of  the medical procedure, half  an hour preceding 
incision closure.

Blinding
Blinding of  the procedure was impossible as the patients 
were physically wearing thoracoabdominal binders, and 
they could Not hide the main element of  the study to make 
the trial Non-biased.

Pre-op Medications
Patients were given Kefzol (antibiotic) once before the 

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surgical procedure. These medications were administered 
to reduce the Surgical Site Infections (SSI) rate.
Surgical Site Infections (SSI) influence the oncologic 
consideration of  breast cancer patients because of  
postpones in different Treatments, expansions in care 
expenses, failed recreations, and possibly development in 
recurring disease rates. The rate of  surgical site infections 
has decisively increased in literature as per the reported 
cases. The increment range is dramatic as if  it skyrocketed 
from 0.8% to being raised to 26% (Edwards et al., 2009; 
Neumayer et al., 2007; Prospero et al., 2006).

Surgical Procedure
In simple mastectomy, the whole breast tissue is eliminated; 
axillary tissues are undisturbed. At times, the “sentinel 
lymph Node” — the central axillary lymph Node that the 
metastasizing cancer cells would be supposed to deplete 
into — is taken out. Individuals who go through a simple 
mastectomy can typically leave the clinic after a brief  stay. 
Regularly, a drainage tube is embedded during a medical 
procedure in their chest and joined to a little suction device 
to eliminate subcutaneous liquid. These are Normally 
eliminated a few Days after the medical practice as drainage 
declines to less than 20-30 ml daily. When this procedure 
is completed on a tumourous breast, it is also performed 
on a healthy breast to prevent cancer recurrence. The 
decision of  this “contralateral prophylactic” choice has 
become more run of  the mill as of  late in California, most 
outstanding in individuals more youthful than 40, moving 
from only 4% to 33% from 1998 to 2011. Nonetheless, 
the potential advantages give off  an impression of  being 
negligible, best case scenario, without any genetic markers, 
as per a huge scope study distributed in 2014 (Kurian et al., 
2014; Newman, 2014; Tanner, 2014).

Customary Incision Closure
The incision was then closed using conventional, 
absorbable skin sutures, and None of  the modern skin 
flaps were utilized after the mastectomy.

Medications after Surgery
Most patients were given 500mg of  Kefzol every six hours 
for two weeks. Some patients were advised to use Kefzol 
only once for seven Days, and only a few were given 

Augmentin for 7 Days.

Hospital Stay
The patients have been advised of  the duration of  their 
hospital stay as per their post-op condition. Some were 
even kept in the hospital for about ten Days.

Post-op Complications
Several complications occur post-mastectomy or MRM, 
including lymphedema, shoulder morbidity and seroma 
aspiration. The one we encountered during this RCT was 
a hematoma. Hematoma is a pool of  mostly coagulated 
blood that structures in an organ, tissue, or body space. A 
hematoma is typically brought about by a messed up vein 
that was harmed by a medical procedure or a physical injury 
(Hematoma, toenail, gross, 2013). It can accumulate at any 
place in the body, including the brain. Not at all like cancer, 
breast hematomas are mostly harmless. Treatment of  a 
hematoma relies upon its seriousness. Small hematomas 
might resorb following a couple of  Days. More extreme 
hematomas that keep expanding might expect a medical 
procedure to deplete the gathered blood or potentially 
control any draining vessels and reclose the surgical site 
(Hoda & Cheng, 2017). 

Follow up
The patients were told to show up for the follow-up 2-3 
weeks before mastectomy or MRM.

Evaluation
The assessment was tentatively directed in the two groups, 
with the same philosophy and absence of  pain convention. 
The principal factors explored were seroma production, 
pain before and after the medical procedure, post-op 
complications, the number of  Days the drain was attached, 
etc. Symptomatic seroma was characterized as an axillary 
liquid collection initiating inconvenience or pain with 
clinical consultation.

Exclusion Criteria
The exclusion criteria were based on the following points: 
(1) Patients unwilling to share their details publicly. (2) 
Patients who were unable to comprehend the reason 
behind the study and its extent and, for that reason, 

Table 1: Basic history collection of  the trial.

N
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2

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7

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8

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11

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94
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54

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12

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15

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41
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70
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23

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61
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51
23

21
8

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s

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5 

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25

Tr
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51
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82
4

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-5

9

Sa
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en

tra
l

M
RM

0 N
o

ID
C

<
50

 m
l

Ye
s

2-
5 

cm

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Table 2: Data of  drain collection and post-op condition.
N

o.

M
et

s 
to

 L
N

s Antibiotics Coverage

H
ei

gh
t

W
ei

gh
t

B
M

I

D
ra

in
 1

D
ra

in
 2

R
em

ov
al

 o
f 

D
ra

in
 o

n 
Po

st
-O

p 
D

ay
 N

o.

Ph
ys

io
th

er
ap

y 
E

xe
rc

is
es

Pa
tie

nt
 C

om
pl

ia
nc

e 
w

ith
 W

ea
rin

g 
th

e 
B

el
t

Po
st

-o
p 

co
m

pl
ic

at
io

ns

1 N1 Kefzol Once Pre-Op, 
Keflex 500 Mg 
q6hrs 2 Weeks

17
5

79
.3

25
.9

111ml 
TO 5ml

120ml TO 
25ml

D
ay

 1
4

Ye
s

C
on

tro
l G

ro
up

N
o

2 N0 Kefzol Once Pre-Op, Keflex 
500 Mg q6hrs 2 Weeks

16
3

89
.6

33
.7

200ml 
TO 
20ml

130ml TO 
10ml

D
ay

 1
4

Ye
s

C
on

tro
l G

ro
up

N
o

3 N2 Kefzol Once Pre-Op, Keflex 
500 Mg q6hrs 2 Weeks

14
8.

5

72
.9

33

160ml 
TO 
30ml

130ml TO 
10ml

D
ay

 1
4

Ye
s

C
on

tro
l G

ro
up

N
o

4 N0 Kefzol Once Pre-Op, Post-
Op Augmentin 7 Days

16
4

62
.7

23
.3

132ml 
TO 
20ml

0

D
ay

 9

N
ot

 n
ee

de
d

C
on

tro
l G

ro
up

N
o

5 N2 Kefzol Once Pre-Op, Keflex 
500 Mg q6hrs 2 Weeks

15
0

97
.1

43
.2

210ml 
TO 10 
ml

115ml TO 
10ml

D
ay

 3
3

Ye
s

C
on

tro
l G

ro
up

N
o

6 N2 Kefzol Once Pre-Op, Keflex 
500 Mg q6hrs 2 Weeks

15
8

87
.3

35

150ml 
TO 65 
ml

100ml TO 
10ml

D
ay

 1
8

Ye
s

C
on

tro
l G

ro
up

N
o

7 N2 Kefzol Once Pre-Op

15
0

54
.4

24
.2

167ml 
TO 
15ml

110ml TO 
5ml

D
ay

 1
4

Ye
s

C
on

tro
l G

ro
up

N
o

8 Kefzol Once Pre-Op, Keflex 
500 Mg q6hrs 2 Weeks

16
6

85
.5

31

140ml 
TO 
23ml

120ml TO 
5ml

D
ay

 1
4

Ye
s

C
on

tro
l G

ro
up

N
o

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9 N3 Kefzol Once Pre-Op, Keflex 
500 Mg q6hrs 2 Weeks

15
9

67
.5

26
.7

150ml 
TO 
30ml

120ml TO 
10ml

D
ay

 1
4

Ye
s

C
on

tro
l G

ro
up

H
em

at
om

a 
Po

st
-O

p 
D

ay
 3

10 N0 Kefzol Once Pre-Op

16
4

76
.9

28
.6

100ml 
TO 5ml

0

D
ay

10

N
ot

 n
ee

de
d

C
on

tro
l G

ro
up

N
o

11 N1 Kefzol Once Pre-Op, Keflex 
500 Mg q6hrs 2 Weeks

15
5

69
.7

29

150ml 
TO 
40ml

110ml TO 
10ml

D
ay

 1
4

Ye
s

C
on

tro
l G

ro
up

N
o

12 N0 Kefzol Once Pre-Op, Keflex 
500 Mg q6hrs 2 Weeks

15
5

64 26
.6

170ml 
TO 
10ml

0

D
ay

 1
4

N
ot

 n
ee

de
d

C
on

tro
l G

ro
up

N
o

13 N0 Kefzol Once Pre-Op and 
Post-Op for 7 Days

15
6

56 23
.7

130ml 
TO 
10ml

0
D

ay
 1

4

N
ot

 n
ee

de
d

C
on

tro
l G

ro
up

N
o

14 N1 Kefzol Once Pre-Op and 
Post-Op for 7 Days

15
3

76
.9

32
.9

140ml 
TO 
10ml

124ml TO 
5ml

D
ay

 9

Ye
s

Ye
s

N
o

15 N3 Kefzol Once Pre-Op, Keflex 
500 Mg q6hrs 2 Weeks

16
4

82
.1

30
.5

122 
ml TO 
10ml 

120ml TO 
5ml

D
ay

 1
4

Ye
s

Ye
s

N
o

16 N1 Kefzol Once Pre-Op, Keflex 
500 Mg q6hrs 2 Weeks

16
8

73 25
.9

220ml 
TO 
10ml

160ml TO 
5ml

D
ay

 1
4

Ye
s

Ye
s

N
o

17 N1 Kefzol Once Pre-Op, Post-
Op Augmentin 7 Days

15
8

71
.4

28
.6

150ml 
TO 
30ml

0

D
ay

 1
4

N
ot

 n
ee

de
d

N
o

N
o

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18 N1 Kefzol Once Pre-Op, Keflex 
500 Mg q6hrs 2 Weeks

15
0

58
.4

26

120ml 
TO 
20ml

50ml TO 
5 ml

D
ay

 1
4

Ye
s

Ye
s

N
o

19 N0 Kefzol Once Pre-Op and 
Post-Op for 7 Days

16
0

86
.6

34
.5

190ml 
TO 
10ml

0

D
ay

 1
4

N
ot

 n
ee

de
d

Ye
s

N
o

20 N3 Kefzol Once Pre-Op, Keflex 
500 Mg q6hrs 2 Weeks

16
3

90 53

200ml 
TO 
10ml

170ml TO 
10ml

D
ay

 1
4

Ye
s

Ye
s

N
o

21 N0 Kefzol Once Pre-Op, Keflex 
500 Mg q6hrs 2 Weeks

15
6

73
.2

30
.1

150ml 
TO 
15ml 

0

D
ay

 1
4

N
ot

 n
ee

de
d

Ye
s

N
o

22 N1 Kefzol Once Pre-Op, Keflex 
500 Mg q6hrs 2 Weeks

14
2.

5

77
.2

38

144 
ml TO 
10ml

110ml TO 
10ml

D
ay

 1
4

Ye
s

Ye
s

N
o

23 N0 Kefzol Once Pre-Op, Keflex 
500 Mg q6hrs 2 Weeks

14
7

80
.4

37
.2

110 to 
5ml 

0
D

ay
 1

4

N
ot

 n
ee

de
d

Ye
s

N
o

24 N1 Kefzol Once Pre-Op, Keflex 
500 Mg q6hrs 2 Weeks

15
8

72 28
.8

130ml 
TO 
20ml

120ml TO 
5ml

D
ay

 1
4

Ye
s

Ye
s

N
o

25 N1 Kefzol Once Pre-Op, Keflex 
500 Mg q6hrs 2 Weeks

16
2

70
.7

26
.9

110ml 
TO 
25ml

150ml TO 
10ml

D
ay

 1
4

Ye
s

Ye
s

N
o

did Not sign the consent form. (3) Patients who never 
showed up for a follow-up. (4) Those whose drainage 
charts were Not managed were also excluded.

RESULTS AND DISCUSSION
As per the research, no recognizable difference was found 
in the group of  patients wearing the thoracoabdominal 
binders compared to the patients not wearing the binder 
in the quantity of  seroma production.

Statistical Analysis 
When the values of  the drain removal of  the control group 
(G1) and treatment group (G2) are compared statistically, 
the standard deviation of  Drain 1 of  the control group 
(s=16.753) and that of  the treatment group (s=7.5252) 
vary greatly as it gives us the p-value of  0.01249. This 
shows a distinguishable difference, but the SD values of  
Drain 2 (G1= 6.95 & G2 = 3.964) did not show a distinct 
difference with the p-value of  0.07272, implementing the 
non-significant difference in the SD of  both groups. This 

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nullifies the difference in the first drain and thus brings 
us back to the conclusion that there was no remarkable 
difference in the seroma production of  the binder and 
non-binder groups. (All the calculations were performed 
using SPSS (IBM SPSS Statistics for Windows, version 
25, New York, USA).

Primary Outcome
The quantity of  drain extracted the first time ranged from 
5ml to 65ml in the control group, while in the treatment 
group, the range was from 5ml to 30 ml. In the second 
drain removal, the field dropped from 0ml to 25ml in 
the control group, while the treatment group’s range fell 
from 0ml to 10ml (Table No.2). However, since only 25 
patients were left for the conclusive results, the result’s 
significance declined. Also, the statistical analysis suggests 
otherwise.
The sizes of  the tumors extracted (Table No. 1), BMI, 
body weight (Table no. 2) etc., are also mentioned in 
the tables. The size of  the tumor barely affects seroma 
production, but the increased body weight and BMI may 
increase the levels of  seroma production (Srivastava et al., 
2012). 

Secondary Outcomes 
Although there was no major difference in the seroma 
production of  the patients undergoing mastectomy or 
MRM, many other positive changes were detected in this 
RCT.

Pain
Binders worked as a pain-relief  mechanism as they 
applied enough pressure on the thoracoabdominal region 
to relieve the patients of  postoperative pain after the 
surgery. In another study (Daniel & Matheson, 1969), it 
was also evident that abdominal binders acted as pain-
relieving equipment. It was a short study following in a 
logical order, where patients were their control group 
(n=16). This study was conducted on patients who had to 
undergo major abdominal surgeries and wore binders for 
only about 10 minutes. The patients brought to attention 
that they felt a minor difference in the feeling of  pain 
while wearing the binder. They felt less pain than those 
without the abdominal binder.

Pulmonary Stress
The patient reported that the stress in breathing was 
significantly reduced for those wearing the binders 
compared to those not. To support this statement, one 
RCT (C. M. Larson et al., 2009) (n=23) reported the aid 
of  abdominal binders in the pulmonary function stating 
that the vital capacity of  the lungs increased recognizably 
in the binder group compared to the control group.

Physical Activity
As it is common knowledge, shoulder immobility is also 
frequent post-breast surgery. The patients wearing a 
binder showed less discomfort while moving their hands 

than the non-binder group. Still, the hand movement 
remained restricted. An approach supported by most 
breast surgeons is to suggest that patients limit signs 
at the shoulder to move away from the midline to no 
more prominent than 90 and that active upper extremity 
physiotherapy is postponed until drainage catheters have 
been eliminated (Vitug & Newman, 2007).
Also, a study (Rothman et al., 1966) suggested that 
abdominal binders greatly help with the patient’s physical 
functions. (Where physical function means a six-minute 
walk) (n=75). The two groups were examined for the 
distance they walked in the given time before the surgery 
and five days following the surgery. It was concluded 
that the binder group walked a significantly longer 
distance on day 5 than the non-binder group, which 
supports our statement claiming improvement in hand 
and shoulder movement post-surgery with the help of  a 
thoracoabdominal binder. Nevertheless, still, the results 
are ambiguous when compared to other research. 
It is safe to say that binders may help in improving 
physical function. Still, more studies need to implement 
thoracoabdominal binders as safe and beneficial post-op 
care equipment.

Discomfort
Discomfort is one of  the main reasons many patients 
disagree with using a binder. The feeling of  uneasiness 
and constantly being compressed may be a difficulty most 
people do not want to endure. The pressure binder applied 
to the incision site may be uncomfortable to some, but 
it benefits as a pain-relieving compression for others. In 
one RCT, 21 out of  28 patients (in the abdominal binder 
group) claimed no discomfort due to the adherence to 
the binder, while only 7 reported pain (Jiang et al., 2021).
Seroma formation is considered one of  the most 
recurrent complications post-breast surgery, be it a 
mastectomy, Modified Radical Mastectomy, or even 
reconstructive surgery (Agrawal et al., 2006; Carless & 
Henry, 2006; Kumar et al., 1995; Woodworth et al., 2000). 
Needle aspiration for seroma removal is a common 
cause of  post-op clinical visits (Hashemi et al., 2004). 
This is why seroma reduction using different measures 
has become the goal of  breast surgeons to make breast 
surgery possible with lesser pain and complications.
Seroma accumulation causes the skin to stretch and causes 
it to sag as well, creating an even more discomforting and 
unpleasing appearance. Suppose the seroma formation 
continues for an extended period. In that case, it causes 
a delay in the healing of  the wound, may cause skin flap 
necrosis, and be associated with surgical site infections 
and arm lymphedema (Kuroi et al., 2006).  
The pathophysiology or the cause of  seroma is still 
vague (Ebner et al., 2014), but the leading cause, as per 
many RCTs and Meta-analyses, is considered dead space 
(Agrawal et al., 2006; de Rooij et al., 2020; Kuroi et al., 2006; 
Van Bastelaar et al., 2016; van Bemmel et al., 2011). One 
of  the main reasons for this RCT is to study the results of  
applying pressure with the help of  a thoracoabdominal 

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binder to compress the dead space and reduce seroma 
production. Although the findings of  this RCT are 
unclear and do not present extraordinary evidence in 
support of  the usage of  binders for the reduction of  
seroma formation, a couple of  other larger studies do 
give positive outcomes analyzing the use of  binders in 
seroma reduction, pain management and improvement in 
physical activity (lesser shoulder morbidities) (Rothman 
et al., 1966).
One of  the studies (Kontos et al., 2008) shows that 
pressure dressings (which can be modified into 
thoracoabdominal binders) make a significant difference 
in seroma production post-mastectomy. Two hundred 
patients were randomized into two groups; one of  them 
was the PD (pressure dressing) group, while the other 
was non-PD. All the different surgical techniques and pre 
and postoperative supervision were kept similar. Their 
discoveries are in favor of  PD as a viable, economical and 
simple to-apply technique for the decrease (a) of  the time 
with drains in situ after MRM, (b) the number of  patients 
producing seromas and (c) of  the seroma aspirations. 
This might diminish further complexities, require clinical 
consideration, and cut expenses (Kontos et al., 2008).
The use of  such pressure dressings, binders and 
compressions of  the wound has been discovered widely 
in other horizons of  innovative surgery (P. K. Chowbey 
et al., 2000; K. A. LeBlanc, 2004). However, it is still in 
the early stages of  breast surgery. More widespread, 
larger and more organized studies need to be executed to 
accumulate more and more verification and evidence to 
make the use of  binders a common practice in the field 
of  surgery (Rothman et al., 1966). 
Pain management post-surgery is one of  the extensively 
recognized uses of  binders in other fields of  study. 
Once again, in breast surgery, the use is limited. Thus, 
the findings are ambiguous on whether it is beneficial or 
not. However, the mechanical support it provides to the 
wound decreases patients’ discomfort due to incisional 
pain. The pressure the binder applies supports the 
incision and even helps in wound healing to a small extent 
(Rettenmaier et al., 2017).
Arm morbidity is one of  the most inconvenient long-
lasting complexities of  breast cancer therapy and 
essentially affects the regular routines of  breast cancer 
survivors (BCS). Despite its significance, persistent arm 
morbidity is moderately under-investigated (Kwan et al., 
2002). Arm and shoulder morbidity reduces the quality 
of  life of  (BCS) greatly. Binders have shown slight 
improvement in shoulder movement in a few patients. 
This is also a reason to consider more research devoted 
to thoracoabdominal binder applications to determine 
their effectiveness, as references have been provided for 
inappreciable improvement in physical activity with the 
help of  binders in this RCT.
Cancer is fatal, so most patients also have mental health 
issues. Surgeries also bring out different levels of  anxiety 
in most patients. This psychological stress worsens post-
surgery due to the thought of  any negative symptoms 

related to the operation (Rhodes et al., 2000). An RCT 
(Cheifetz et al., 2010) compared the pre and postoperative 
stress levels in patients divided into binder and no-
binder groups to study the use of  binders. The outcome 
suggested that the stress level remained the same in the 
binder group and rose significantly in the non-binder 
group. Similarly, a prospective controlled study (Daniel 
& Matheson, 1969) was held for a similar cause; it 
was detected that the psychological distress caused by 
coughing was exponentially reduced in the binder group 
compared to the others.
The main reason behind the better emotional response 
in the binder group is the feeling of  being held by the 
pressure of  the binder wrapping around the incision. The 
pain of  coughing post-surgery acts like trauma; thus, the 
compression provided by the binder eases that pain and 
helps reduce stress levels. It also facilitates the breathing 
process by covering the pain caused by the wound at the 
surgical site, and easy breathing also aids in the help of  
relieving depressive thoughts. 
As per the fore mentioned studies, binders help manage 
postoperative psychological distress; some patients 
feel extremely uncomfortable in the tightness of  a 
thoracoabdominal binder. This discomfort is personal 
and non-scientific (Rothman et al., 1966). This study 
concludes that using binders causes no compromise to 
pulmonary function.

CONCLUSION
For the sake of  actual implementation, the current 
investigation is uncertain as to the impact of  
thoracoabdominal binders on seroma development. 
Although there is faint evidence in favor of  a slight 
reduction in the production of  free fluid, the lack of  
concrete evidence and other factors like increased BMI 
etc., masking the impacts of  compression by the binders 
make its effectiveness ambiguous. Insubstantial evidence 
is also mentioned in the binder groups’ positive pain 
management effects, emotional and physical distress, 
and moving capability. Thus, more large-scale studies 
and comparative meta-analyses need to be taken to 
justify using thoracoabdominal binders in patients 
post-mastectomy and MRM. B binders can help make 
breast surgery care post-surgery less painful and more 
economical for the patients, resulting in fewer clinic visits.

LIMITATION
One restriction of  this study was puzzling due to 
neoadjuvant chemotherapy and axillary clearance. 
Axillary clearance and neoadjuvant chemotherapy have 
been demonstrated to expand the chances of  patients 
undergoing seroma production.
Another limitation may be the small size of  the groups. 
Most trials require more cases to ensure the results are not 
constricted to a small environment or group of  people.
Also, the lack of  versatility, as the entire trial is based in one 
country, may restrict the results to a certain environment.
The pathophysiological reason for seroma formation is 

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still ambiguous. Still, some surgeons might suggest that 
the BMI, other medical conditions and surgery at the 
same site before breast surgery may be a reason behind 
it. Moreover, in our data [table no.1], it can be seen that 
most patients suffer from conditions like diabetes mellitus 
and hypertension. In table no. 2, we can see the raised 
BMIs of  some patients, which may cause hindrances in 
evaluating the accurate results.

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