Total Sealing Technique in Axillary Lymph Node Dissection for Breast Cancer: A Comprehensive Review of Clinical Outcomes and Health Economic Value

Background/Objectives: Axillary lymph node dissection (ALND) remains an essential component of breast cancer surgery for selected patients, particularly those with clinically involved nodes or residual disease after neoadjuvant therapy. However, ALND is consistently associated with postoperative lymphatic morbidity, including seroma formation, prolonged drainage, and breast cancer–related lymphedema (BCRL), which adversely affect quality of life and increase healthcare utilization. This review aims to evaluate contemporary ALND strategies with a particular focus on the Total Sealing Technique (TST), a technique-centered approach that emphasizes comprehensive lymphatic sealing rather than device substitution. Methods: A narrative review of the literature was conducted to synthesize available experimental, histopathological, and clinical evidence related to TST. Studies evaluating biological mechanisms, perioperative outcomes, long-term lymphatic complications, and health economic implications of TST were reviewed and contextualized alongside data from conventional electrocautery-based techniques and energy-device substitution strategies. Results: Across published studies, TST is consistently associated with reductions in postoperative drainage volume, duration of drain placement, incidence of seroma formation, and length of hospital stay. Importantly, long-term follow-up data demonstrate a marked reduction in the incidence of BCRL compared with conventional ALND techniques. These benefits are achieved without increases in operative time, perioperative complications, or compromise of oncological safety. From a health economic perspective, reductions in inpatient hospitalization, outpatient seroma management, and long-term lymphedema-related care translate into meaningful per-patient cost savings. Conclusions: The available evidence supports TST as a reproducible and scalable surgical strategy that effectively reduces both short-term postoperative morbidity and long-term lymphatic complications following ALND. By addressing lymphatic injury at the time of initial surgery, TST aligns with contemporary priorities in breast cancer care, including survivorship, quality of life, and value-based healthcare delivery.