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Effect of Drain Placement on Infection, Seroma, and Return to Operating Room in Expander-Based Breast Reconstruction

Ollech, Caleb J. MEng*; Block, Lisa M. MD*; Afifi, Ahmed M. MD*†; Poore, Samuel O. MD, PhD*

doi: 10.1097/SAP.0000000000001174
Breast Surgery
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Introduction There is significant variability in the location and management of drains in breast reconstruction, with most surgeons attempting to shorten the duration of drains while preventing complications possibly related to early removal. The aim of this work was to compare our experiences with placement of 1 versus 2 drains in tissue expander breast reconstruction.

Methods This is a retrospective cohort study comparing 2 groups of patients after breast tissue expander placement in a complete submuscular pocket and without the use of acellular dermal matrix. In the first group, a single subcutaneous drain was placed; in the second group, both a subcutaneous and a submuscular drain were placed. These groups were evaluated on their relative duration of drain placement, incidence of seroma formation, incidence of infection, and rates of complication necessitating return to operating room (OR).

Results The single-drain group was found to have a significantly shorter duration of drain placement (14.58 vs 22.84 days, P = < 0.01) as well as lower incidence of return to OR for complications after expander placement (8.3% vs 17.6%, P = 0.040), with no difference in rate of seroma formation (6.9% vs 14.7%, P = 0.114) or infection (1.4% in the single-drain group vs 8.8% in the 2-drain group, P = 0.054).

Conclusions Compared with a two-drain approach, a single subcutaneous drain yields shorter total duration of drain placement and lower rate of complications requiring return to OR while not resulting in higher rates of seroma or infection. It has become our standard approach to use a single subcutaneous drain in patients having a breast tissue expander placed in a submuscular pocket.

From the *Department of Surgery, University of Wisconsin, Madison, WI; and †Department of Surgery, Cairo University, Cairo, Egypt.

Received February 14, 2017, and accepted for publication, after revision May 16, 2017.

Conflicts of interest and sources of funding: This study was supported by Shapiro Research Program.

Reprints: Ahmed M. Afifi, MD, University of Wisconsin, G5/356 CSC, 600 Highland Avenue, Madison, WI 53792. E-mail: ahafifi@yahoo.com.

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.