Asian Journal of Research in Surgery

Background: Flap fixation, or quilting, is a technique used to close the dead space following breast resection. Although multiple studies have shown that quilting reduces postoperative seroma rates, evidence regarding its effect on drainage duration remains inconsistent.

Aims: This study was undertaken to evaluate its effectiveness in reducing postoperative drainage duration following modified radical mastectomy with axillary lymph node dissection.

Study Design: Single-centre, prospective comparative study.

Place and Duration of Study: Regional Cancer Centre, Department of Surgical Oncology, Coimbatore Medical College Hospital, from January 2024 to August 2025.

Methodology: Fifty-six adult female patients diagnosed with breast cancer, with or without prior chemotherapy, were included. In the quilting group (n = 27), the dead space was obliterated by placing interrupted absorbable sutures between the undersurface of the mastectomy flap and the pectoralis major muscle in multiple superior rows spaced 2–3 cm apart and a single inferior row. The surgical drain was removed once the daily output was less than 30 mL for two consecutive days.

Results: The median time to drain removal was shorter in the quilting group (14 days) than in the conventional group (20 days), although the difference was not statistically significant (P = 0.107; log-rank P = 0.19). Multivariable Cox regression showed that quilting closure was not independently associated with time to drain removal (adjusted HR 1.07; P = 0.830). Instead, greater resection mass was identified as the primary independent determinant of prolonged drainage (adjusted HR 0.37 per kg; P = 0.029).

Conclusion: Although the primary determinant of drain duration was the extent of the surgical burden, larger randomised studies using standardised quilting protocols are needed to clarify the effectiveness of quilting in reducing drainage duration.