Prophylactic Drain Use in Breast Expander-to-Implant Exchange: Necessity or Nuisance?

Area of Science:

• Plastic Surgery
• Reconstructive Surgery
• Breast Reconstruction

Background:

• Surgical drains are commonly used in implant-based breast reconstruction (IBBR).
• The necessity of drains during the expander-to-implant exchange stage is not well-defined.
• This study aims to clarify drain usage in the second stage of IBBR.

Purpose of the Study:

• To determine the necessity of surgical drains during the expander-to-implant exchange in IBBR.
• To identify clinical scenarios where drains are beneficial or detrimental.

Main Methods:

• Retrospective analysis of expander-to-implant exchanges (2018-2023).
• Comparison of complication rates between patients with and without drains.
• Propensity score matching and multivariable logistic regression to control for bias.

Main Results:

• Unmatched analysis showed higher complication rates (overall, implant exposure, explantation) in the drain group, especially in the prepectoral plane.
• Propensity score matching and regression analysis indicated drains neither predicted nor prevented complications.
• No significant difference in complications was found between drain and no-drain groups after matching.

Conclusions:

• Surgical drains are not protective against adverse outcomes in the second stage of IBBR.
• Drain placement may increase complication rates, particularly in the prepectoral plane.
• Drains may benefit patients with significant dissection, capsular issues, or comorbidities.