Breast cancer is the most frequently diagnosed malignancy and the leading cause of cancer-related mortality among women worldwide.1,2 The burden of breast cancer has continued to increase in low- and middle-income countries, including India, where it has overtaken cervical cancer as the most common cancer among women.3,4 Although substantial advances have been achieved in breast cancer screening, diagnostic modalities, surgical techniques, systemic therapies, and multidisciplinary management, a significant proportion of women in developing countries still present with locally advanced disease, thereby increasing treatment complexity and the risk of postoperative morbidity.3-5

Clinical stage at the time of diagnosis remains one of the most important determinants of therapeutic decision-making and prognosis in patients with breast cancer.5,6 In many resource-constrained settings, modified radical mastectomy (MRM) continues to represent the standard surgical treatment for a considerable proportion of operable breast cancers.6 Early postoperative complications, including seroma formation, surgical site infection, skin flap necrosis, and postoperative haemorrhage, are associated with delayed wound healing, prolonged hospital stay, postponement of adjuvant therapy, increased healthcare expenditure, and deterioration in patients' quality of life. Careful evaluation of these postoperative outcomes is therefore essential for assessing the quality of surgical care and identifying opportunities to optimize perioperative management and improve patient outcomes.6,7

Despite extensive research on the epidemiology, molecular characteristics, and biological behaviour of breast cancer, relatively few studies from Indian tertiary care centres have comprehensively evaluated the relationship between clinical stage at presentation, surgical management, and early postoperative outcomes.3,4 Institution-based data are therefore valuable for understanding real-world patterns of disease presentation, monitoring postoperative morbidity, and strengthening evidence-based surgical care in the local healthcare setting.3,7 Therefore, this study aimed to describe the clinical stage at presentation, document the surgical management performed, and determine the frequency and pattern of early postoperative complications among patients with carcinoma breast.

This cross-sectional study was conducted over a period of 18 months, including a 6-month follow-up period, in the Department of General Surgery at ESIC Medical College Hospital and Post Graduate Institute of Medical Sciences and Research (ESIC-MH & PGIMSR), Rajajinagar, Bengaluru, after obtaining approval from the Institutional Ethics Committee. The study aimed to evaluate the clinical stage at presentation, surgical management, and early postoperative outcomes among patients with carcinoma breast. A total of 50 female patients with clinically palpable breast lumps and fine needle aspiration cytology (FNAC)-confirmed carcinoma breast were included. All eligible patients presenting during the study period were enrolled after obtaining written informed consent. Female patients aged 20–80 years with palpable breast lumps and FNAC-confirmed carcinoma breast were included in the study. Patients with benign breast diseases, recurrent carcinoma breast, and male breast carcinoma were excluded. A detailed clinical history was obtained using a structured proforma, followed by thorough clinical examination. Baseline demographic characteristics, presenting complaints, tumour location, tumour size, axillary nodal status, and clinical stage were documented systematically for all participants. All patients underwent routine laboratory investigations, including complete blood count, urine analysis, random blood sugar, renal function tests, and electrocardiography. Disease evaluation was carried out using appropriate radiological and pathological investigations, including ultrasonography and/or mammography of the breast, chest radiography, ultrasonography of the abdomen and pelvis, liver function tests, serum alkaline phosphatase estimation, bone imaging whenever indicated, positron emission tomography/computed tomography (PET/CT) or oncological CT in selected patients, and trucut/core biopsy where appropriate. Clinical staging was established based on the findings of clinical examination and relevant investigations to facilitate treatment planning. Patients underwent surgical management according to the stage of disease, with modified radical mastectomy performed in all confirmed cases. Neoadjuvant chemotherapy, chemotherapy, radiotherapy, and hormonal therapy were administered whenever clinically indicated as part of multidisciplinary management. Following surgery, patients were monitored for early postoperative complications, including seroma formation, flap necrosis, surgical site infection, and secondary haemorrhage. The cases were subsequently followed up until the end of the study for routine postoperative clinical assessment. The collected data were entered into Microsoft Excel and analysed using IBM SPSS Statistics version 16.0. Categorical variables, including baseline clinicopathological characteristics, clinical stage, treatment modalities, and early postoperative complications, were summarised as frequencies and percentages. Continuous variables, such as duration of surgery, estimated blood loss, number of lymph nodes removed, number of positive lymph nodes, drain output, drain duration, and length of hospital stay, were presented as mean with standard deviation and median with interquartile range. Fisher’s exact test was used to assess the association between clinical stage at presentation and the occurrence of early postoperative complications because of the small frequencies in certain stage categories. A p-value of <0.05 was considered statistically significant.

Among the 50 study participants, the majority were aged 41–50 years (42.0%) and presented with a breast lump as the sole complaint (78.0%). The left breast (60.0%) and upper outer quadrant (78.0%) was the most frequently involved tumour location, while most tumours measured 2–5 cm (92.0%). Clinically palpable axillary lymph node involvement (N1) was observed in 78.0% of patients, indicating that most participants presented with locoregionally advanced disease requiring definitive surgical management. (Table 1)

Figure 1: Clinical stage at presentation among the study participants (N = 50)

Table 1: Baseline clinicopathological characteristics of the study participants (N = 50)

Most patients presented with Stage II disease (84.0%), with Stage IIB being the predominant clinical stage (62.0%), followed by Stage IIA (22.0%). Stage III and Stage IV disease accounted for 10.0% and 6.0% of cases, respectively, while no patient presented with Stage I disease. All study participants underwent modified radical mastectomy as the definitive surgical treatment. (Figure 1)

All 50 study participants underwent modified radical mastectomy. Neoadjuvant chemotherapy was administered to 14 patients (28.0%), while 41 patients (82.0%) received chemotherapy as part of their overall oncological management. Radiotherapy was administered to 35 patients (70.0%), and 31 patients (62.0%) received hormonal therapy. (Table 2)

Table 2: Treatment modalities received among the study participants (N = 50)

*Multiple treatment modalities were received by individual patients; therefore, the percentages do not total 100%.

The mean duration of surgery was 118.4 ± 18.6 minutes, with a median duration of 115 minutes (IQR: 100–125 minutes). The mean estimated intraoperative blood loss was 186.5 ± 64.2 mL, while the median blood loss was 140 mL (IQR: 100–230 mL). An average of 16.8 ± 4.1 axillary lymph nodes were removed during surgery, with a median of 15 nodes (IQR: 11–20 nodes). The mean number of histopathologically positive lymph nodes was 3.4 ± 2.7, with a median of 3 nodes (IQR: 1–4 nodes). (Table 3)

Table 3: Operative characteristics of the study participants (N = 50)

SD: Standard deviation; IQR: Interquartile range

The mean cumulative drain output was 486.8 ± 158.4 mL, with a median of 450 mL (IQR: 380–580 mL). The mean drain duration was 8.2 ± 2.1 days, with a median of 8 days (IQR: 7–10 days). The mean hospital stay was 9.1 ± 2.6 days, while the median duration was 9 days (IQR: 7–11 days). (Table 4)

Table 4: Postoperative recovery characteristics of the study participants (N = 50)

SD: Standard deviation; IQR: Interquartile range

More than half of the patients (54.0%) had an uncomplicated postoperative course. Seroma was the most common early postoperative complication, occurring in 36.0% of patients, followed by surgical site infection (8.0%), flap necrosis (4.0%), and secondary haemorrhage (2.0%). Some patients experienced more than one postoperative complication. (Table 5)

Table 5: Early postoperative complications following surgical management among the study participants (N = 50)

*Multiple responses were possible among patients who developed postoperative complications; therefore, the percentages do not total 100%.

The proportion of patients developing at least one early postoperative complication increased with advancing clinical stage, from 27.3% in Stage IIA to 100.0% in Stage IV. Complications were observed in 45.2% of Stage IIB, 50.0% of Stage IIIA, and 66.7% of Stage IIIB patients. This association between clinical stage and postoperative complications was statistically significant (Fisher’s exact test, p = 0.041). (Table 6)

Table 6: Association between clinical stage and occurrence of early postoperative complications among the study participants (N = 50)

# Fisher’s exact test; Statistically significant at p<0.05

Breast carcinoma often presents at an advanced stage in resource-limited settings, increasing surgical complexity and postoperative morbidity; therefore, assessing the clinical stage and early outcomes is essential for improving perioperative planning and timely management. This hospital-based cross-sectional study included 50 women aged ≥18 years with histopathologically confirmed breast carcinoma undergoing definitive surgery. Demographic, clinical, imaging, histopathological, and TNM staging details were recorded. All patients underwent modified radical mastectomy, and operative duration, blood loss, lymph-node yield and positivity, drain output and duration, hospital stay, and early complications, including seroma, surgical site infection, flap necrosis, and secondary haemorrhage, were prospectively documented. Breast carcinoma in the present study predominantly affected women in the fifth decade, with 42.0% aged 41–50 years, followed by 51–60 years (24.0%), 30–40 years (20.0%), 61–70 years (12.0%), and 71–80 years (2.0%). These findings are comparable to Naqvi SK et al.8 (2024) (48.50±12.30 years), Shlaka SR et al.9 (2024) (45.15±14.27 years; 47.9% aged 31–49 years), Sikandar F et al.10 (2026) (51.4±10.2 years; 62.8% aged 41–60 years), and Rizvi FH et al.11 (2020) (51.79±12.65 years), although Shlaka SR et al.9 reported 13.4% of patients aged ≤30 years. A painless breast lump was the commonest presenting complaint (78.0%), similar to Sikandar F et al.10 (2026) (93.3%), while nipple discharge (6.0%) closely matched the 6.3% reported by Shlaka SR et al.9 (2024). Left-sided tumours predominated (60.0%), unlike Sikandar F et al.10 (2026), who reported slight right-sided predominance (54.3%). The upper outer quadrant was the commonest site (78.0%), consistent with the known anatomical distribution of breast carcinoma. Most tumours (92.0%) measured 2–5 cm, comparable to the mean tumour size of 4.2±1.3 cm reported by Sikandar F et al.10 (2026), whereas Ray AS et al.12 (2024) documented larger (>5 cm) tumours in 45.0% of patients. Clinically palpable axillary lymph-node involvement (N1) was observed in 78.0% of patients, higher than the 67.1% reported by Sikandar F et al.10 (2026) and the 50.0% N1 rate reported by Ray AS et al.12 (2024), although Ray AS et al.12 reported a higher node-negative (N0) rate of 41.7% compared with 22.0% in the present study. These findings indicate a substantial locoregional disease burden at presentation. Stage II disease predominated (84.0%), with Stage IIB accounting for 62.0% and Stage IIA for 22.0%, while Stage III and IV disease constituted 10.0% and 6.0%, respectively; notably, no patient presented with Stage I disease. Similar trends of advanced-stage presentation were reported by Rizvi FH et al.11 (2020), who observed locally advanced disease in 59.6% of patients, Shlaka SR et al.9 (2024), who reported Stage III disease in 57.7% and Stage II disease in 33.8%, and Sikandar F et al.10 (2026), who documented Stage III disease in 60.0%, Stage II in 20.0%, and Stage IIIC in 20.0%. In contrast, Naqvi SK et al.8 (2024) reported earlier presentation, with 36.1% of patients in Stage I and 63.9% in Stage II. Overall, the predominance of Stage II disease and absence of Stage I cases in the present study reflect delayed diagnosis, limited screening, and restricted healthcare access in resource-limited settings. All patients in the present study underwent modified radical mastectomy (MRM) (100.0%) as the definitive surgical procedure, similar to Naqvi SK et al.8 (2024), Ray AS et al.12 (2024), Shlaka SR et al.9 (2024), and Sikandar F et al.10 (2026), who also reported a 100.0% MRM rate. In contrast, Rizvi FH et al.11 (2020) performed MRM in 68.0% of patients and breast-conserving surgery (BCS) in 32.0%. The universal use of MRM in the present study reflects the predominance of Stage II and advanced disease, where breast conservation is often not feasible. The mean operative duration was 118.4±18.6 minutes (median: 115 minutes; IQR: 100–125), comparable to Sikandar F et al.10 (2026) (115±25 minutes) and Rizvi FH et al.11 (2020) (1.7±0.47 hours). Mean estimated blood loss was 186.5±64.2 mL (median: 140 mL; IQR: 100–230), closely matching the 210±60 mL reported by Sikandar F et al.10 (2026), indicating that MRM is associated with relatively low intraoperative blood loss when performed using standard oncological techniques. The mean number of lymph nodes retrieved was 16.8±4.1 (median: 15; IQR: 11–20), which was comparable to Rizvi FH et al.11 (2020) (16.82±6.8) and Sikandar F et al.10 (2026) (15.4±3.7). Histopathologically positive lymph nodes averaged 3.4±2.7 (median: 3; IQR: 1–4), similar to Rizvi FH et al.11 (2020) (2.63±3.5), while Sikandar F et al.10 (2026) reported axillary nodal involvement in 65.7% of patients, with 40.0% having ≥4 positive nodes. These findings indicate adequate axillary clearance and a substantial burden of nodal metastasis requiring appropriate adjuvant therapy. The mean postoperative drain duration was 8.2±2.1 days (median: 8 days; IQR: 7–10), comparable to Sikandar F et al.10 (2026) (7.3±2.4 days), while Naqvi SK et al.8 (2024) removed drains when output decreased below 20–30 mL/day, usually by the seventh postoperative day. The mean hospital stay was 9.1±2.6 days (median: 9 days; IQR: 7–11), longer than that reported by Sikandar F et al.10 (2026) (6.2±2.1 days), Rizvi FH et al.11 (2020) (2.1±0.88 days), and Naqvi SK et al.8 (2024), who discharged most patients on the second postoperative day. These differences likely reflect variations in institutional discharge protocols, drain management practices, and postoperative monitoring. Seroma was the commonest early postoperative complication in the present study, occurring in 36.0% of patients. This was higher than the rates reported by Naqvi SK et al.8 (2024) (23.0%), Ray AS et al.12 (2024) (21.7%; 32.4% following neoadjuvant chemotherapy), Sikandar F et al.10 (2026) (16.2%), and Shlaka SR et al.9 (2024) (12.0%), but considerably higher than the 5.3% reported by Rizvi FH et al.11 (2020). Despite this variation, seroma remains the most frequent complication following modified radical mastectomy and axillary dissection, with reported incidences ranging from 12% to 36%, influenced by differences in surgical technique, drain management, and diagnostic criteria. Surgical site infection (SSI) occurred in 8.0% of patients, comparable to Shlaka SR et al.9 (2024) (7.7%) and Sikandar F et al.10 (2026) (6.7%), while Naqvi SK et al.8 (2024) and Ray AS et al.12 (2024) reported slightly higher rates of 11.4% and 11.7%, respectively. In contrast, Rizvi FH et al.11 (2020) documented a substantially lower SSI rate of 1.06%. Skin flap necrosis was observed in 4.0% of patients, closely matching Rizvi FH et al.11 (2020) (4.3%), Sikandar F et al.10 (2026) (2.9%), and Shlaka SR et al.9 (2024) (1.4%). Secondary haemorrhage occurred in 2.0% of patients, similar to Sikandar F et al.10 (2026) (1.9%), Rizvi FH et al.11 (2020) (3.19%), and Ray AS et al.12 (2024) (3.3%). Overall, SSI, flap necrosis, and postoperative haemorrhage occurred at rates consistent with those reported in contemporary literature and were managed using standard postoperative care. The present study also demonstrated a statistically significant association between clinical stage and early postoperative complications (Fisher's exact test, p=0.041), with complication rates increasing from 27.3% in Stage IIA to 100.0% in Stage IV disease. Similar observations were reported by Sikandar F et al.10 (2026), who identified tumour size >3 cm (p=0.018), positive lymph nodes (p=0.007), and comorbidities (p=0.022) as significant predictors of complications. Ray AS et al.12 (2024) likewise found T3 tumours (p=0.0120) and diabetes mellitus (p=0.0081) to be associated with increased postoperative morbidity, while Naqvi SK et al.8 (2024) reported higher seroma (30.7%) and SSI (12.8%) rates in Stage II than Stage I disease (9.0% each). In contrast, Shlaka SR et al.9 (2024) found no significant association between tumour stage (p=0.800) or comorbidities (p=0.935) and postoperative complications. These findings suggest that advanced disease and greater tumour burden increase postoperative morbidity, although surgical technique and perioperative care also substantially influence outcomes. Strengths and Limitations The study comprehensively assessed clinical stage, surgical management, operative characteristics, and early postoperative outcomes using standardized evaluation and uniform treatment, with the significant association between advancing stage and complications providing clinically relevant evidence. However, its single-centre cross-sectional design, small sample of 50 patients, absence of comparison with breast-conserving surgery, and limited follow-up restricted generalizability and prevented assessment of long-term recurrence, survival, functional recovery, quality of life, and potential confounding factors.

The study found that most patients with carcinoma breast presented with Stage II disease, particularly Stage IIB, and commonly had 2–5 cm tumours with axillary nodal involvement. All patients underwent modified radical mastectomy, with additional chemotherapy, radiotherapy, and hormonal therapy as indicated. Although more than half had an uncomplicated recovery, seroma was the most frequent early postoperative complication. The significant increase in complications with advancing clinical stage highlights the importance of early detection, timely staging, appropriate surgical management, and close postoperative surveillance to improve outcomes.

Acknowledgement: We sincerely thank the faculty of the institute for helping us in each aspect of the study.

Funding: None

Conflict of interest: None declared

Ethical approval: The study was approved by the Institutional Ethics Committee

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