Compression Bandage Dressing in Mastectomy Patients
Compression bandaging after mastectomy is NOT routinely recommended, as high-quality evidence demonstrates it fails to reduce postoperative drainage or seroma formation and may actually increase seroma complications requiring aspiration. 1
Evidence Against Routine Compression Bandaging
The strongest evidence comes from a randomized controlled trial of 135 mastectomy patients that directly evaluated compression dressing efficacy:
No reduction in drainage volume: After 4 days, wound drainage was nearly identical between compression (490 cc) and standard dressing groups (517 cc; P = 0.48) 1
No earlier drain removal: Total days with drain were similar (compression = 6.4 days, standard = 6.1 days; P = 0.69) 1
Increased seroma complications: Compression dressing significantly increased seroma aspirations per patient (compression = 2.9, standard = 1.8; P <0.01), with the effect most pronounced in modified radical mastectomy patients (compression = 3.1, standard = 1.7; P <0.01) 1
When Compression IS Indicated
Compression therapy has a completely different role in the treatment of established lymphedema following mastectomy, not for immediate postoperative wound management:
For lymphedema management: Compression stockings reduced arm swelling in 54% of patients with established postmastectomy lymphedema, and combination therapy with compression sleeves and intermittent pneumatic compression reduced volume in 68% of patients 2
Timing distinction: Postmastectomy lymphedema typically develops within the first year after surgery (17 patients within 6 months, 29 patients at one year), not immediately postoperatively 2
Appropriate Postoperative Wound Management
Based on the evidence, standard postoperative dressing approaches should focus on:
Meticulous hemostasis during surgery to avoid hematoma formation, which complicates postoperative evaluation 3
Standard dressing (such as a front-fastening surgical bra) rather than circumferential compression wrapping 1
Closed-catheter drainage with removal when output is <50 cc per day 1
Monitoring for complications: Wound infection occurs in 18% of patients, seroma in 25%, and there is significant association between seroma formation and wound infection (P <0.05) 4
Critical Clinical Pitfall
Do not confuse immediate postoperative compression bandaging (not beneficial and potentially harmful) with compression therapy for established lymphedema (beneficial but applied weeks to months later). 1, 2 The timing and indication are completely different, and applying compression immediately after mastectomy based on its efficacy for lymphedema would be an error in clinical reasoning.