The drain game: back drains for latissimus dorsi breast reconstruction

The pedicled latissimus dorsi myocutaneous (LD) flap is a popular breast reconstruction choice, representing approximately 50% of procedures undertaken in the UK. Donor site drain use may reduce complication rates, however no evidence exists regarding the duration of back drain use for LD flap breast reconstruction and calls have been made in the literature to investigate this further.

To compare inpatient hospital stay, drainage parameters and donor-site complications associated with closed suction back drain removal by post-operative day (POD) 3 regardless of output (early group), with removal after POD 3 where instructions were documented by drainage volume/24 h ± output consistency (late group), in post-mastectomy LD reconstruction donor sites.

A retrospective review of LD breast reconstruction procedures, performed between January 2010 and July 2011, was undertaken to ensure 1 year minimum follow-up per patient.

There were 81 patients who underwent unilateral LD breast reconstructions; 78 hospital records contained complete documentation. There were 48 patients in the late removal group and 30 patients in the early removal group. The mean drain removal day (5.42 ± 0.17 days vs. 2.87 ± 0.06 days, p < 0.001), total drainage (907.71 ± 76.07 ml vs. 492.67 ± 35.15 ml, p < 0.0001) and hospital inpatient stay (4.60 ± 0.19 days vs. 3.63 ± 0.17 days, p < 0.001) were greater for patients in the late group, versus the early group. There were no differences in total complications (16.67%(8/48) vs. 10%(3/30), p = 0.41), seroma (6.25%(3/48) vs. 6.67%(2/30), p = 0.94), dehiscence (4.17%(2/48) vs. 3.33%(1/30), p = 0.85) or haematoma rates (10.42%(5/48) vs. 0%(0/30), p = 0.07) between patients in the late and early groups; seroma sub-analysis also indicated no differences in number of seroma aspirations, duration of drainage (months) and mean total drainage (ml) prior to resolution.

These data suggest significant advantages for patients who have back drains removed by POD 3, without increased post-operative complications including seroma rates, and we recommend drain removal and patient discharge by POD 3.