Back to 2025 Abstracts
One or Two Drains? A Propensity Score-Matched Analysis of Post-Operative Complications after Tissue Expander Placement
Jennifer Wang
*1, Ronnie Shammas
1, Francis Graziano
1, Lillian A. Boe
2, Jonas Nelson
11Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY; 2Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
BACKGROUND: Drains used in the postoperative setting decrease the risk of seromas which are associated with infection and delayed wound healing. However, use of multiple drains is associated with increased patient discomfort. The impact of drain quantity on postoperative complications after immediate breast reconstruction remains unclear. Our study aimed to evaluate the association between number of drains used and the development of post-operative complications after immediate two-stage implant-based breast reconstruction.
METHODS: A propensity score-matched analysis was conducted of patients who had a unilateral mastectomy followed by immediate tissue expander (TE) placement from January 2017 to December 2023. Patients were grouped by the use of one or two drains and were matched on BMI, plane of implant placement, ADM use, whether they had a sentinel lymph node biopsy, and total intraoperative TE fill volume. Outcomes of interest included surgical site infection, seroma, seroma management plan, mastectomy skin flap necrosis, hematoma, implant exposure, and TE removal within 90 days of index surgery.
RESULTS: After propensity score match, 1,076 patients were included in the final analysis: 538 in each group. There were no significant differences in rates of seroma (13% vs 10%, p=0.23), surgical site infection (12% vs 12%, p=0.76), or TE removal (7.5% vs 6.1%, p=0.46) between patients who had one drain as compared to those who had two. The rate of 90 day overall post-operative complications were comparable between usage of one versus two drains (28% vs. 27% respectively, p=0.66). Of the patients who had post-operative seroma, patients who had one drain placed did not require more invasive seroma management compared to those who had two drains (p=0.89).
CONCLUSION: Patients who received one drain after immediate TE placement do not have significantly greater rates of complication, including seroma, surgical site infection, or TE removal, compared to those who received two drains. Generally, surgeons can safely use only one drain following immediate TE placement.
