Mastectomy Blood Loss: Can We Predict the Need for Blood Transfusion?


Background: Bleeding during total mastectomy and axillary clearance is inevitable, and blood transfusion is often required when bleeding is excessive. Objectives: To predict the probability of transfusion, we tested the hypothesis: “The blood loss during total mastectomy and axillary clearance in Accra is related to the stage of the disease and the size of the breast”. Design: Patients undergoing total mastectomy and axillary clearance were prospectively studied from June 2008 to June 2011. The breast and used swabs were weighed immediately after surgery, and patients’ full blood count was checked before and after surgery. Setting: Surgical wards and theatres of the Korle Bu Teaching Hospital, Accra. Results: There were 80 women, aged 31 to 85 (Mean 50, SD 3.4) years, with body mass index between 20 and 46 (mean 23.7, median 28). Fifty one (63.8%) had Stage 3 disease, and 47 (58.8%) required neoadjuvant chemotherapy. Pre-operative haemoglobin was 9.5 g/dl to 14.9g/dl (mean 11.6 g/dl, SD 1.1). Post-operative haemoglobin was 9.2 g/dl - 13.4 g/dl (mean 10.9, SD 0.97). The mean drop in haemoglobin level was 0.75 g/dl. None of the 80 patients received blood transfusion. There was a linear increase in breast weight with increasing BMI. Blood loss ranged from 95 g to 1185 g, with majority (59; 73.8%) losing between 100 and 400 gram blood. Only 2 patients (2.5%) lost more than 1000 g of blood. Less than 400 g of blood was lost with breast weights below 2 kg. Above that, blood loss increased to more significant volumes. Conclusions: Blood loss during total mastectomy and axillary clearance in Accra was directly related to the size of the breast. There was, however, inconclusive association between tumour stage and blood loss.

Share and Cite:

Clegg-Lamptey, J. and Dakubo, J. (2014) Mastectomy Blood Loss: Can We Predict the Need for Blood Transfusion?. International Journal of Clinical Medicine, 5, 1294-1299. doi: 10.4236/ijcm.2014.520164.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Moersch, R.N., Patrick, R.T. and Clagett, O.T. (1960) The Use of Hypotensive Anesthesia in Radical Mastectomy. Annals of Surgery, 911-918.
[2] Hellevuo, C., Salmi, A., Muuronen, E. and Autio, V. (2002) The Use of Lidocaine with Adrenaline Reduces Blood Loss and Operating Time in Free TRAM Breast Reconstruction. The European Journal of Plastic Surgery, 25, 243-246.
[3] Kakos, G.S. and James, A.G. (1970) The Use of Cautery in “Bloodless” Radical Mastectomy. Cancer, 26, 666-668.<666::AID-CNCR2820260327>3.0.CO;2-F
[4] Kurtz, S.B. and Frost, D.B. (1995) A Comparison of Two Surgical Techniques for Performing Mastectomy. European Journal of Surgical Oncology, 21, 143-145.
[5] Putyrskii, L.A. (1992) The Use of CO2-Laser and Blood Loss during Mastectomy. Ross Med Zh., 5, 16-17.
[6] Deo, S.V.S., Shukla, N.K., Asthana, S., Niranjan, B. and Srinivas, G. (2002) A Comparative Study of Modified Radical Mastectomy Using Harmonic Scalpel and Electrocautery. Singapore Medical Journal, 43, 226-228.
[7] Adwani, A. and Ebbs, S.R. (2006) Ultracision Reduces Acute Blood Loss but Not Seroma Formation after Mastectomy and Axillary Dissection: A Pilot Study. International Journal of Clinical Practice, 60, 562-564.
[8] Clegg-Lamptey, J. and Hodasi, W.M. (2007) A Study of Breast Cancer in Korle Bu Teaching Hospital: Assessing the Impact of Health Education. Ghana Medical Journal, 41, 72-77.
[9] Vibhute, M., Kamath, S.K. and Shetty, A. (2000) Blood Utilisation in Elective General Surgery Cases: Requirements, Ordering and Transfusion Practices. Journal of Postgraduate Medicine, 46, 13-17.
[10] Trudnowski, R.J. and Rico, R.C. (1974) Specific Gravity of Blood and Plasma at 4 and 37 Degrees C. Clinical Chemistry, 20, 615-616.
[11] Wood, K., Cameron, M. and Fitzgerald, K. (2008) Breast Size, Bra Fit and Thoracic Pain in Young Women: A Correlational Study. Chiropractic & Osteopathy, 16, 1.

Copyright © 2023 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.