Single Versus Double Drainage After Modified Radical Mastectomy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
7 affiliations
- 1Department of Biochemistry and Molecular Medicine, College of Medicine, Alfaisal University, Riyadh 11533, Saudi Arabia
- 2Royal College of Surgeons in Ireland, D02 YN77 Dublin, Ireland
- 3University of Glasgow, Glasgow G12 8QQ, UK
- 4College of Medicine and Medical Sciences, Arabian Gulf University, Manama 22979, Bahrain
- 5Faculty of Medicine, Alexandria University, Alexandria 21531, Egypt
- 6Ministry of Health, Kuwait City 13001, Kuwait
- 7Royal College of Surgeons in Ireland, Busaiteen 228, Bahrain
Abstract
Background: Modified radical mastectomy (MRM) with axillary lymph-node dissection frequently leads to postoperative seroma formation, prompting the routine use of closed-suction drainage. While standard practice traditionally involves placing two drains, one axillary and one pectoral/sub-flap, this approach increases patient discomfort and limits mobility. A single-drain strategy may alleviate this burden, but concerns persist that inadequate drainage could increase the risk of seroma. Methods: A comprehensive search across five databases was conducted up to 10 August 2026 for randomized controlled trials (RCTs) comparing single axillary drainage with double (axillary plus pectoral/sub-flap) drainage after MRM. The primary outcome was postoperative seroma formation. Risk ratios (RR) and mean differences (MD) with 95% confidence intervals (CI) were pooled using a random-effects model, and the certainty of evidence was rated using the GRADE approach. Results: Nine RCTs involving 856 patients were included. There was no statistically significant difference between single and double drainage regarding the incidence of postoperative seroma (RR: 1.13, 95% CI [0.86, 1.47]; p = 0.37; low certainty), corresponding to 30 more seromas per 1000 patients (95% CI: 33 fewer to 110 more). Also, the strategies yielded comparable outcomes for the volume of aspirated seroma (MD: 0.19 mL; p = 0.97) and the number of post-removal aspirations (MD: 0.13; p = 0.32). Total drain output, drain duration, and the risk of complications, including hematoma (RR: 2.01; p = 0.27), flap necrosis (RR: 0.72; p = 0.36), and surgical site infection (RR: 0.75; p = 0.60), did not differ significantly between the two groups. Conclusions: Single axillary drainage after MRM was not associated with significant differences in postoperative seroma formation, aspirated seroma volume, number of seroma aspirations, total drain output, drain duration, hematoma, flap necrosis, or surgical-site infection compared with double axillary plus pectoral/sub-flap drainage. However, the certainty of evidence was low for most outcomes and the confidence intervals were compatible with clinically relevant differences, so equivalence cannot be concluded; adequately powered trials with standardized seroma definitions and patient-centered outcomes are needed.
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BibTeX
@article{abuzaid2026single,
title = {{Single Versus Double Drainage After Modified Radical Mastectomy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials}},
author = {Ahmed Abu-Zaid and Yara S. Alseddiqi and Mohammad M. Sarkhouh and Laila Alkanderi and Fahhad Nafea Alajmi and Hussain A. Alshammari and Fatemah A. Ahmad and Othman M. Alrashidi and Ali Alshooli and Ali J. Alrashidi and Mohammad M. Jassem and Layal T. Alwazzan and Mohammad F. Al-Mutairi and Abdullah M. Alharran},
journal = {Journal of Clinical Medicine},
year = {2026},
month = oct,
doi = {10.3390/jcm15218391},
url = {https://www.mdpi.com/2077-0383/15/21/8391},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Single Versus Double Drainage After Modified Radical Mastectomy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
AU - Ahmed Abu-Zaid
AU - Yara S. Alseddiqi
AU - Mohammad M. Sarkhouh
AU - Laila Alkanderi
AU - Fahhad Nafea Alajmi
AU - Hussain A. Alshammari
AU - Fatemah A. Ahmad
AU - Othman M. Alrashidi
AU - Ali Alshooli
AU - Ali J. Alrashidi
AU - Mohammad M. Jassem
AU - Layal T. Alwazzan
AU - Mohammad F. Al-Mutairi
AU - Abdullah M. Alharran
PY - 2026
DA - 2026/10/28
JO - Journal of Clinical Medicine
DO - 10.3390/jcm15218391
UR - https://www.mdpi.com/2077-0383/15/21/8391
AB - Background: Modified radical mastectomy (MRM) with axillary lymph-node dissection frequently leads to postoperative seroma formation, prompting the routine use of closed-suction drainage. While standard practice traditionally involves placing two drains, one axillary and one pectoral/sub-flap, this approach increases patient discomfort and limits mobility. A single-drain strategy may alleviate this burden, but concerns persist that inadequate drainage could increase the risk of seroma. Methods: A comprehensive search across five databases was conducted up to 10 August 2026 for randomized controlled trials (RCTs) comparing single axillary drainage with double (axillary plus pectoral/sub-flap) drainage after MRM. The primary outcome was postoperative seroma formation. Risk ratios (RR) and mean differences (MD) with 95% confidence intervals (CI) were pooled using a random-effects model, and the certainty of evidence was rated using the GRADE approach. Results: Nine RCTs involving 856 patients were included. There was no statistically significant difference between single and double drainage regarding the incidence of postoperative seroma (RR: 1.13, 95% CI [0.86, 1.47]; p = 0.37; low certainty), corresponding to 30 more seromas per 1000 patients (95% CI: 33 fewer to 110 more). Also, the strategies yielded comparable outcomes for the volume of aspirated seroma (MD: 0.19 mL; p = 0.97) and the number of post-removal aspirations (MD: 0.13; p = 0.32). Total drain output, drain duration, and the risk of complications, including hematoma (RR: 2.01; p = 0.27), flap necrosis (RR: 0.72; p = 0.36), and surgical site infection (RR: 0.75; p = 0.60), did not differ significantly between the two groups. Conclusions: Single axillary drainage after MRM was not associated with significant differences in postoperative seroma formation, aspirated seroma volume, number of seroma aspirations, total drain output, drain duration, hematoma, flap necrosis, or surgical-site infection compared with double axillary plus pectoral/sub-flap drainage. However, the certainty of evidence was low for most outcomes and the confidence intervals were compatible with clinically relevant differences, so equivalence cannot be concluded; adequately powered trials with standardized seroma definitions and patient-centered outcomes are needed.
SN - 2077-0383
ER -