Factors Associated with Immediate Complications after Mastectomy with Axillary Lymph Node Dissection for Breast Cancer: A Critical Review of Studies Published from 2016 to 2025

Abstract

Immediate morbidity after mastectomy with axillary lymph node dissection (ALND) remains clinically consequential despite refinements in operative technique and perioperative care. This critical narrative review evaluates factors associated with complications arising during admission or approximately the first 30 postoperative days, with particular attention to seroma requiring intervention, surgical-site infection, haematoma, skin-flap necrosis and wound-healing problems. Peer-reviewed studies published between 2016 and 2025 were identified through targeted searches of accessible scholarly resources and citation tracing; studies reporting broader breast-surgery populations or longer follow-up were interpreted as indirect evidence. The strongest recurring associations concern excess body mass and the additional tissue and lymphatic disruption accompanying ALND, although effect estimates depend on the complication definition, operative case mix and adjustment for confounding. Diabetes, smoking, hypertension, older age, treatment sequencing and operative complexity have less uniform outcome-specific support. Randomised studies and syntheses generally favour mechanical dead-space closure for reducing clinically significant seroma, but individual trials differ, and improvement in infection, necrosis or patient-centred recovery is not established consistently. Evidence for cyanoacrylate sealants and tranexamic acid is conflicting, whereas prolonged prophylactic antibiotics have not demonstrated clear benefit in a dedicated multicentre trial. Major obstacles to inference include inconsistent definitions, variable drainage and aspiration protocols, mixing of mastectomy with breast-conserving surgery or reconstruction, inadequate separation of early from chronic complications, and sparse external validation of prediction tools. The available literature supports risk-aware perioperative planning and selective consideration of technically appropriate flap fixation rather than a universal complication-prevention package. Future multicentre studies should enrol clearly defined mastectomy–ALND cohorts, report standardised 30-day outcomes and assess both effectiveness and unintended consequences.