47 Pectoral fascia preservation in oncological mastectomy incidence of seroma was slightly lower in the PF preservation arm (31% vs 39.8%), but these differences were not statistically significant. In the RCT by Abdelhamid et al a significant lower incidence of seroma formation was observed in the PF preservation group of 5.6% vs 24.3%. Unfortunately, no definition of seroma was provided in this study.10 Better coverage of the prostheses by PF preservation may theoretically lower the infection rates as well as the rates of implant extrusion.7, 13 There is a 3.8% incidence of infectious complications in breast surgery in general (including mastectomy and lumpectomy).29 Higher rates of infections have been reported for mastectomies, ranging from 5.3-8.9%,30-32 and of 6.0% of all patients undergoing a mastectomy with TE placement.33 In the studies by Sandelin et al and Salgarello et al, the occurrence of infections after mastectomy with PF preservation was 2.7% and 6.4%, respectively. The rates of implant extrusion of 1.6% and 0.9% in studies by Sandelin and Salgarello respectively are lower than the least (1.9%) reported in the literature.34 However, based on these two studies no definite conclusions can be drawn on these topics. By removing the fascia, the oncologic surgeon may also compromise the underlying muscle to a certain extent. This may cause a risk for implant extrusion, but may also result in localized and irregular bulging of the muscle as expansion occurs. Unfortunately, there are very little data about assessing the esthetic results with and without the fascia being preserved. The cosmetic outcomes reported were based on the subjective surgeons’ and their colleagues opinions. These data do not seem to be sufficient to answer the question if PF preservation leads to better reconstructive outcomes.13 Abdelhamid only described an improvement of skin flap appearance after PF preservation, but did not provide any information on how this was tested.10 Future studies should focus on the objective assessment of the effect of PF preservation on reconstructive outcomes. Additional advantages of PF preservation reported were decreased intraoperative blood loss, decreased operative time, decreased drain output and decreased time to drain removal.10 However, these are results from only one study, and the techniques and drainage protocols may differ from other centers. A frequently heard argument to promote PF resection is that it facilitates pathological examination of the dorsal margins. However, in our experience, the PF is rarely identified microscopically and it is not likely that a preserved fascia will lead to more false positive margins.14, 16 3
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