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European Journal of Plastic Surgery
Published in: European Journal of Plastic Surgery 3/2020

01-06-2020 | Mastectomy | Original Paper

Arnica montana and Bellis perennis for seroma reduction following mastectomy and immediate breast reconstruction: randomized, double-blind, placebo- controlled trial

Authors: Adi Maisel Lotan, Yoav Gronovich, Ido Lysy, Rami Binenboym, Nirit Eizenman, Barak Stuchiner, Oren Goldstein, Polina Babai, Menahem Oberbaum

Published in: European Journal of Plastic Surgery | Issue 3/2020

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Abstract

Background

Seroma is a common surgical complication created by the inflammatory process that follows mastectomy and reconstruction [9‐15]. It is, therefore, common practice to insert surgical drains, which often remain in place for long periods and delay recovery [26, 27]. In light of the many advantages of homeopathic treatment, there has been a global trend of integrating this with conventional medicine [29]. In this study, we examined the effect of Arnica montana and Bellis perennis on seroma prevention after mastectomy and breast reconstruction.

Methods

This was a prospective double-blinded randomized analysis of 55 consecutive patients (78 breasts), who underwent mastectomy and immediate breast reconstruction between January 2016 and August 2017. Patients were randomly assigned and treated with Arnica montana and Bellis perennis or placebo from surgery and up to the time of drain removal.

Results

The mean patient age was 47.9 years. Comorbidities included obesity, diabetes mellitus, essential hypertension, fibromyalgia, and hypothyroidism (1, 4, 6, 2, and 4 patients respectively). Age, body mass index, mastectomy type, and lymph node dissection were similar among groups. Forty-two breasts underwent one-stage procedure, and the remaining were two-stage. Arnica montana and Bellis perennis significantly reduced drain removal time (discharge < 30 ml) by 18% (2.4 days, p < 0.05), 11.1 (6.1) days in the study groups compared with 13.5 (6.4) days in the placebo group. Patient opioid intake was lower (p < 0.057) in the study group. Quality of life, postoperative pain, hemoglobin and cortisol levels, and complications were not associated with any treatment.

Conclusions

Arnica montana and Bellis perennis have been shown to reduce seroma formation and opioid intake following mastectomy and reconstruction. As this treatment lacks side effects and is inexpensive, it should serve as a valuable treatment adjunct in patients undergoing mastectomy and reconstruction.
Level of evidence: Level I, therapeutic study.
Literature
1.
Fitzmaurice C, Dicker D, Pain A et al (2015) The global burden of cancer 2013. JAMA Oncol 1:505–527PubMedCrossRef
2.
Serletti MJ, Fosnot J, Nelson JA et al (2011) Breast reconstruction after breast cancer. Plast Reconstr Surg 127(6):124e–135ePubMedCrossRef
3.
Al-Ghazal SK, Fallowfield L, Blamey RW (2000) Comparison of psychological aspects and patient satisfaction following breast conserving surgery, simple mastectomy and breast reconstruction. Eur J Cancer 36:1938–1943PubMedCrossRef
4.
Cordeiro PG (2008) Breast reconstruction after surgery for breast cancer. N Engl J Med 359:1590–1601PubMedCrossRef
5.
Atisha D, Alderman AK, Lowery JC, Kuhn LE, Davis J, Wilkins EG (2008) Prospective analysis of long-term psychosocial outcomes in breast reconstruction: two-year postoperative results from the Michigan Breast Reconstruction Outcomes Study. Ann Surg 247:1019–1028PubMedCrossRef
6.
Skovsted Yde S, Brunbjerg ME, Damsgaard TE (2016) Acellular dermal matrices in breast reconstructions — a literature review. J Plast Surg Hand Surg 50(4):187–196PubMedCrossRef
7.
Agarwal S, Kidwell KM, Farberg A, Kozlow JH, Chung KC, Momoh AO (2015) Immediate reconstruction of the radiated breast: recent trends contrary to traditional standards. Ann Surg Oncol 22:2551–2559PubMedPubMedCentralCrossRef
8.
Frasier LL, Holden S, Holden T, Schumacher JR, Leverson G, Anderson B, Greenberg CC, Neuman HB (2016) Temporal trends in postmastectomy radiation therapy and breast reconstruction associated with changes in National Comprehensive Cancer Network guidelines. JAMA Oncol 2:95–101PubMedPubMedCentralCrossRef
9.
Ilonzo N, Tsang A, Tsantes S, Estabrook A, Thu Ma AM (2017) Breast reconstruction after mastectomy: a ten-year analysis of trends and immediate postoperative outcomes. Breast 32:7–12PubMedCrossRef
10.
Agrawal A, Ayantunde AA, Cheung KL (2006) Concepts of seroma formation and prevention in breast cancer surgery. ANZ J Surg 76:1088–1095PubMedCrossRef
11.
Pogson CJ, Adwani A, Ebbs SR (2003) Seroma following breast cancer surgery. Eur J Surg Oncol 29:711–717PubMedCrossRef
12.
Boostrom SY, Throckmorton AD, Boughey JC, Holifield AC, Zakaria S, Hoskin TL, Degnim AC (2009) Incidence of clinically significant seroma after breast and axillary surgery. J Am Coll Surg 208:148–150PubMedCrossRef
13.
Tejler G, Aspegren K (1985) Complications and hospital stay after surgery for breast cancer: a prospective study of 385 patients. Br J Surg 72:542–544PubMedCrossRef
14.
Tadych K, Donegan WL (1987) Postmastectomy seromas and wound drainage. Surg Gynecol Obstet 165:483–487PubMed
15.
Bryant M, Baum M (1987) Postoperative seroma following mastectomy and axillary dissection. Br J Surg 74(12):1187PubMedCrossRef
16.
Sampathraju S, Rodrigues G (2011) Seroma formation after mastectomy: pathogenesis and prevention. Ind Ass of Sur Oncology
17.
Bracaglia R, D'Ettorre M, Gniuli D, Gigliofiorito P, Gentileschi S, Mingrone G (2011) Morbidly obese patients undergoing bariatric and body contouring surgery: psychological evaluation after treatments. J Plast Reconstr Aesthet Surg 64(9):1246–1248PubMedCrossRef
18.
Bracaglia R, D'Ettorre M, Gentileschi S, Mingrone G, Tambasco D (2013) “Kris knife” brachioplasty after bariatric surgery and massive weight loss. Aesthet Plast Surg 37(3):640–642CrossRef
19.
Ferro M, Deodato F, Macchia G, Gentileschi S, Cilla S, Torre G, Padula GD, Nuzzo M, Massaccesi M, Valentini V, Morganti AG (2015) Short-course radiotherapy in elderly patients with early stage non-melanoma skin cancer: a phase II study. Cancer Investig 33(2):34–38CrossRef
20.
Johnson PJ, Jou J, Rhee TG, Rockwood TH, Upchurch DM (2016) Complementary health approaches for health and wellness in midlife and older US adults. Maturitas 89:36–42PubMedCrossRef
21.
22.
Lüdtke R, Rutten AL (2008) The conclusions on the effectiveness of homeopathy highly depend on the set of analyzed trials. J Clin Epidemiol 61:1197–1204PubMedCrossRef
23.
Cucherat M, Haugh MC, Gooch M, Boissel JP (2000) Evidence of clinical efficacy of homeopathy. A meta-analysis of clinical trials. HMRAG Homeopathic Medicines Research Advisory Group. Eur J Clin Pharmacol 56:27–33PubMedCrossRef
24.
Kleijnen J, Knipschild P, Ter Riet G (1991) Clinical trials of homoeopathy. BMJ 9(302):316–323CrossRef
25.
26.
Levine JS, Glass TA, Kushi LH, Schuck JR, Steele L, Jonas WB (1997) Quantitative methods in research on complementary and alternative medicine: a methodological manifesto. Med Care 35:1079–1094CrossRef
27.
Singer SR, Amit-Kohn M, Weiss S, Rosenblum J, Maoz G, Samuels N, Lukasiewicz E, Freedman L, Paltiel O, Itzchaki M, Niska M, Oberbaum M (2010) Traumeel® S Ointment for pain relief following hallux valgus surgery: a randomized controlled trial. BMC Clin Pharmacol 10:9PubMedPubMedCentralCrossRef
28.
Wolf M, Tamaschke C, Mayer W, Heger M (2003) Efficacy of Arnica in varicose vein surgery: results of a randomized, double-blind, placebo-controlled pilot study. Forsch Komplementarmed Klass Naturheilkd 10:242–247 (in German)PubMed
29.
Oberbaum M, Galoyan N, Lerner-Geva L, Singer SR, Grisaru S, Shashar D, Samueloff A (2005) The effect of the homeopathic remedies Arnica montana and Bellis perennis on mild postpartum bleeding — a randomized, double-blind, placebo-controlled study — preliminary results. Complement Ther Med 13:87–90PubMedCrossRef
30.
Schneider C, Schneider B, Hanisch J, van Haselen R (2008) The role of a homoeopathic preparation compared with conventional therapy in the treatment of injuries: an observational cohort study. Complement Ther Med 16:22–27PubMedCrossRef
31.
Oryan A, Moshiri A, Meimandi A (2012) Alcoholic extract of tarantula cubensis improves sharp ruptured tendon healing after primary repair in rabbits. Am J Orthop (Belle Mead NJ) 41:554–560
32.
Oberbaum M, Spira RM, Lukasiewicz E, Armon Y, Samuels N, Singer SR, Barak V, Izbicki G, Einav S, Hersch M (2011) Effect of Traumeel® S on cytokine profile in a cecal ligation and puncture (CLP) sepsis model in rats. J Altern Complement Med 17:909–913PubMedCrossRef
33.
Conforti A, Bellavite P, Bertani S et al (2007) Rat models of acute inflammation: a randomized controlled study on the effects of homeopathic remedies. BMC Complement Altern Med 7:1PubMedPubMedCentralCrossRef
34.
Karakaş FP, Karakaş A, Boran Ç, Türker AU, Yalçin FN, Bilensoy E (2012) The evaluation of topical administration of Bellis perennis fraction on circular excision wound-healing in Wistar albino rats. Pharm Biol 50:1031–1037PubMedCrossRef
35.
Totonchi A, Guyuron B (2007) A randomized, controlled comparison between Arnica and steroids in the management of post-rhinoplasty ecchymosis and edema. Plast Reconstr Surg 120(1):271–274PubMedCrossRef
36.
Lee HS, Yoon HY, Kim IH, Hwang SH (2017) The effectiveness of postoperative intervention in patients after rhinoplasty: a meta-analysis. Eur Arch Otorhinolaryngol 274(7):2685–2694PubMedCrossRef
37.
Seeley BM, Denton AB, Ahn MS, Maas CS (2006) Effect of homeopathic Arnica montana on bruising in face-lifts: results of a randomized, double-blind, placebo-controlled clinical trial. Arch Facial Plast Surg 8(1):54–59PubMedCrossRef
38.
Kang JY, Tran KD, Seiff SR, Mack WP, Lee WW (2017) Assessing the effectiveness of Arnica montana and Rhododendron tomentosum (Ledum palustre) in the reduction of ecchymosis and edema after oculofacial surgery: preliminary results. Ophthal Plast Reconstr Surg 33(1):47–52PubMedCrossRef
39.
Bracaglia R, D'Ettorre M, Gentileschi S, Tambasco D (2014) Was the surgeon a satisfactory informant? How to minimize room for claims. Aesthet Surg J 34(4):632–635PubMedCrossRef
40.
Gornall BF, Myles PS, Smith CL, Burke JA, Leslie K, Pereira MJ, Bost JE, Kluivers KB, Nilsson UG, Tanaka Y, Forbes A (2013) Measurement of quality of recovery using the QoR-40: a quantitative systematic review. Br J Anaesth 111:161–169PubMedCrossRef
41.
Myles PS, Weitkamp B, Jones K, Melick J, Hensen S (2000) Validity and reliability of a postoperative quality of recovery score: the QoR-40. Br J Anaesth 84:11–15PubMedCrossRef
42.
De Oliveira GS Jr, Duncan K, Fitzgerald P, Nader A, Gould RW, McCarthy RJ (2014) Systemic lidocaine to improve quality of recovery after laparoscopic bariatric surgery: a randomized, double-blinded placebo-controlled trial. Obes Surg 24:212–218PubMedCrossRef
43.
Janis JE, Khansa L, Khansa I (2016) Strategies for postoperative seroma prevention: a systematic review. Plast Reconstr Surg 138(1):240–252PubMedCrossRef
44.
Petrek JA, Peters MM, Nori S, Knauer C, Kinne DW, Rogatko A (1990) Axillary lymphadenectomy. A prospective randomized trial of 13 factors influencing drainage, including early or delayed arm mobilization. Arch Surg 125:378–338PubMedCrossRef
45.
Bracaglia R, Fortunato AR, Gentileschi S (2005) A simple way to choose the right implant volume in breast augmentation. Aesthet Plast Surg 29(5):407–408CrossRef
46.
Bracaglia R, Tambasco D, D'Ettorre M, Gentileschi S (2012) “Inverted-Y”: a modified vest-over-pants abdominoplasty pattern following bariatric surgery. Aesthet Plast Surg 36(5):1179–1185CrossRef
47.
Bracaglia R, D'Ettorre M, Gentileschi S, Tambasco D (2012) “Vest over pants” abdominoplasty in post-bariatric patients. Aesthet Plast Surg 36(1):23–27CrossRef
48.
D'Ettorre M, Gniuli D, Bracaglia R, Tambasco D, Mingrone G, Gentileschi S, Massi G (2012) Micro- and macroscopic structural modification of subcutaneous adipose tissue after bariatric surgery. Aesthet Plast Surg 36(1):213–214CrossRef
49.
50.
Loo WT, Chow LW (2007) Factors predicting seroma formation after mastectomy for Chinese breast cancer patients. Indian J Cancer 44:99–103PubMedCrossRef
51.
Campisi CC, Ryan M, Boccardo F, Campisi C (2014) LyMPHA and the prevention of lymphatic injuries: a rationale for early microsurgical intervention. J Reconstr Microsurg 30(1):71–72PubMed
52.
Gentileschi S, Servillo M, Garganese G, Fragomeni S, De Bonis F, Cina A, Scambia G, Salgarello M (2017) The lymphatic superficial circumflex iliac vessels deep branch perforator flap: a new preventive approach to lower limb lymphedema after groin dissection-preliminary evidence. Microsurgery 37(6):564–573PubMedCrossRef
53.
Santonocito C, Concolino P, Lavieri MM, Ameglio F, Gentileschi S, Capizzi R, Rocchetti S, Amerio P, Castagnola M, Zuppi C, Capoluongo E (2005) Comparison between three molecular methods for detection of blood melanoma tyrosinase mRNA. Correlation with melanoma stages and S100B, LDH, NSE biochemical markers. Clin Chim Acta 362(1–2):85–93PubMedCrossRef
54.
Lee KT, Mun GH (2016) Updated evidence of acellular dermal matrix use for implant-based breast reconstruction: a meta-analysis. Ann Surg Oncol 23(2):600–610PubMedCrossRef
55.
Ibrahim AM, Shuster M, Koolen PG, Kim K, Taghinia AH, Sinno HH, Lee BT, Lin SJ (2013) Analysis of the National Surgical Quality Improvement Program database in 19,100 patients undergoing implant-based breast reconstruction: complication rates with acellular dermal matrix. Plast Reconstr Surg 132(5):1057–1066PubMedCrossRef
56.
Jordan SW, Khavanin N, Kim JY (2016) Seroma in prosthetic breast reconstruction. Plast Reconstr Surg 137(4):1104–1116PubMedCrossRef
57.
Purushotham AD, McLatchie E, Young D, George WD, Stallard S, Doughty J, Brown DC, Farish C, Walker A, Millar K, Murray G (2002) Randomized clinical trial of no wound drains and early discharge in the treatment of women with breast cancer. Br J Surg 89:286–292PubMedCrossRef
58.
Puttawibul P, Sangthong B, Maipang T, Sampao S, Uttamakul P, Apakupakul N (2003) Mastectomy without drain at pectoral area: a randomized controlled trial. J Med Assoc Thail 86:325–331
59.
60.
Hart AM, Duggal C, Pinell-White X, Losken A (2017) A prospective randomized trial of the efficacy of fibrin glue, triamcinolone acetonide, and quilting sutures in seroma prevention after latissimus dorsi breast reconstruction. Plast Reconstr Surg 139(4):854e–863ePubMedCrossRef
61.
Mun GH (2015) Fibrin sealants and quilting suture for prevention of seroma formation following latissimus dorsi muscle harvest: a systematic review and meta-analysis. Aesthet Plast Surg 39(3):399–409CrossRef
62.
Bellavite P, Marzotto M, Olioso D, Moratti E, Conforti A (2014) High-dilution effects revisited. 1. Physicochemical aspects. Homeopathy 103:4–21PubMedCrossRef
63.
Bellavite P, Marzotto M, Olioso D et al (2014) High-dilution effects revisited. 2. Pharmacodynamic mechanisms. Homeopathy 103:22–43PubMedCrossRef
64.
Witt CM, Bluth M, Albrecht H, Weisshuhn TE, Baumgartner S, Willich SN (2007) The in-vitro evidence for an effect of high homeopathic potencies – a systematic review of the literature. Complement Ther Med 15:128–138PubMedCrossRef
65.
Bonamin LV, Endler PC (2010) Animal models for studying homeopathy and high dilutions: conceptual critical review. Homeopathy 99:37–50PubMedCrossRef
66.
Endler P, Thieves K, Reich C, Matthiessen P, Bonamin L, Scherr C, Baumgartner S (2010) Repetitions of fundamental research models for homeopathically prepared dilutions beyond 10-23: a bibliometric study. Homeopathy 99:25–36PubMedCrossRef
67.
Linde K, Clausius N, Ramirez G, Melchart D, Eitel F, Hedges LV, Jonas WB (1997) Are the clinical effects of homeopathy placebo effects? A meta-analysis of placebo-controlled trials. Lancet 350(9081):834–843PubMedCrossRef
68.
Barnes J, Resch KL, Ernst E (1997) Homeopathy for postoperative ileus? A meta-analysis. J Clin Gastroenterol 25(4):628–633PubMedCrossRef
69.
Pittman TA, Fan KL, Knapp A, Frantz S, Spear SL (2017) Comparison of different acellular dermal matrices in breast reconstruction: the 50/50 study. Plast Reconstr Surg 139(3):521–528PubMedCrossRef
70.
Knackstedt R, Gatherwright J, Moreira A (2018) Direct-to-implant breast reconstruction in women older than 65 years: a retrospective analysis of complication rate and overall outcomes. Plast Reconstr Surg 141(2):251–256PubMedCrossRef
71.
Stanley SS, Hoppe IC, Ciminello FS (2012) Pain control following breast augmentation: a qualitative systematic review. Aesthet Surg J 32:964–972PubMedCrossRef
72.
Lee A, Gin T, Lau AS, Ng FF (2005) A comparison of patients’ and health care professionals’ preferences for symptoms during immediate postoperative recovery and the management of postoperative nausea and vomiting. Anesth Analg 100:87–93PubMedCrossRef
73.
Cooter RD, Rudkin GE, Gardiner SE (2007) Day case breast augmentation under paravertebral blockade: a prospective study of 100 consecutive patients. Aesthet Plast Surg 31:666–673CrossRef
74.
Lanier ST, Lewis KC, Kendall MC, Vieira BL, De Oliveira G Jr, Nader A, Kim JYS, Alghoul M (2018) Intraoperative nerve blocks fail to improve quality of recovery after tissue expander breast reconstruction: a prospective, double-blinded, randomized, placebo-controlled clinical trial. Plast Reconstr Surg 141(3):590–597PubMedCrossRef
75.
Rowlands M, Krishnan N, Patel A, Ott-Young A (2015) Thoracic intercostal nerve blocks reduce opioid consumption and length of stay in patients undergoing implant-based breast reconstruction. Plast Reconstr Surg 136(5):584e–591ePubMedCrossRef
76.
Kim SY, Kim JM, Lee JH, Song BM, Koo BN (2013) Efficacy of intraoperative dexmedetomidine infusion on emergence agitation and quality of recovery after nasal surgery. Br J Anaesth 111:222–228PubMedCrossRef
77.
De Oliveira GS Jr, Bialek J, Marcus RJ, McCarthy R (2016) Dose-ranging effect of systemic diphenhydramine on postoperative quality of recovery after ambulatory laparoscopic surgery: a randomized, placebo-controlled, double-blinded, clinical trial. J Clin Anesth 34:46–52PubMedCrossRef
78.
Srinivasa DR, Garvey PB, Qi J, Hamill JB, Kim HM, Pusic AL, Kronowitz SJ, Wilkins EG, Butler CE, Clemens MW (2017) Direct-to-implant versus two-stage tissue expander/implant reconstruction: 2-year risks and patient-reported outcomes from a prospective, multicenter study. Plast Reconstr Surg 140(5):869–877PubMedPubMedCentralCrossRef
79.
Colwell AS, Christensen JM (2017) Nipple-sparing mastectomy and direct-to-implant breast reconstruction. Plast Reconstr Surg 140(5S Advances in Breast Reconstruction):44S–50SPubMedCrossRef
80.
Scheflan M, Grinberg-Rashi H, Hod K (2018) Bovine acellular dermal matrix in immediate breast reconstruction: a retrospective, observational study with SurgiMend. Plast Reconstr Surg 141(1):1e–10ePubMedCrossRef
Metadata
Title
Arnica montana and Bellis perennis for seroma reduction following mastectomy and immediate breast reconstruction: randomized, double-blind, placebo- controlled trial
Authors
Adi Maisel Lotan
Yoav Gronovich
Ido Lysy
Rami Binenboym
Nirit Eizenman
Barak Stuchiner
Oren Goldstein
Polina Babai
Menahem Oberbaum
Publication date
01-06-2020
Publisher
Springer Berlin Heidelberg
Published in
European Journal of Plastic Surgery / Issue 3/2020
Print ISSN: 0930-343X
Electronic ISSN: 1435-0130
DOI
https://doi.org/10.1007/s00238-019-01618-7

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