Topical Honey for Wound Healing after Breast Cancer Treatment, with Emphasis on the Mastectomy and Axillary Dissection Wound: A Critical Narrative Review of Evidence from 2000 to 2025

Abstract

Wound complications remain a frequent and consequential part of surgical treatment for breast cancer. After mastectomy with axillary lymph node dissection, women may develop seroma, surgical site infection, skin flap necrosis or dehiscence, and the same chest wall may later be exposed to radiotherapy. Honey, particularly sterilised medical-grade preparations, has re-entered wound care because of its antimicrobial, antibiofilm and immunomodulatory properties, and it is sometimes proposed as a low-cost dressing for women treated for breast cancer. Whether this proposal is justified for the post-mastectomy wound has not previously been examined critically. This narrative review evaluated literature first published between 2000 and 2025, identified through structured searches of biomedical and open scholarly databases with citation chasing, and appraised it qualitatively for design, product characterisation, outcome validity and transferability to the mastectomy and axillary wound. The evidence was organised into five domains: the biology of the post-mastectomy wound, the composition and mechanisms of honey, clinical trials in surgical wounds of other types, studies in breast-cancer-specific wounds, and safety. No controlled clinical study has evaluated topical honey on the closed or complicated wound after mastectomy with axillary dissection. The closest evidence comes from small trials in other closed surgical incisions, from infected post-operative wounds, from radiation dermatitis after breast surgery, where findings are conflicting and largely negative for symptom control, and from malignant fungating breast wounds, where honey performed similarly to silver. Mechanistic data are consistent and plausible for bacterial control, moisture balance and re-epithelialisation, but they do not address seroma, the commonest complication. Product heterogeneity, small samples, unblinded assessment and selective publication limit confidence throughout. Topical medical-grade honey may be a reasonable option for selected superficial, open or infected wounds after breast cancer surgery when standard care has been considered, but routine prophylactic use on mastectomy incisions is not supported. Adequately powered randomised trials using characterised products, standardised wound outcomes and patient-reported measures are required before firmer recommendations can be made.