One or Two Drains? A Propensity Score-Matched Analysis of Postoperative Complications After Tissue Expander Placement

Postoperative drains help reduce seroma formation, which is associated with infection and delayed wound healing; however, multiple drains may increase patient discomfort and prolong hospital stays. The impact of drain quantity on complications after immediate breast reconstruction remains unclear. This study evaluated the association between number of drains used and postoperative complications after mastectomy and tissue expander (TE) placement.

A single-institution, propensity score-matched analysis included patients who underwent a unilateral mastectomy and immediate TE placement from January 2017 to December 2023. Patients were grouped according to the use of one or two drains and matched on body mass index, implant plane placement, acellular dermal matrix use, sentinel lymph node biopsy, intraoperative TE fill volume, and mastectomy weight. Outcomes of interest were postoperative complications, including seroma, surgical site infection, and TE removal within 90 days.

After matching, 984 patients (492 per group) were analyzed. No significant differences were observed in the rates of seroma (13% vs.10%, p = 0.23), 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 with those who had two drains. Overall 90-day complication rates were comparable (28% vs. 27%, p = 0.66) between groups, and seroma management did not differ based on one versus two drains (p = 0.89).

Patients who receive one drain after TE placement do not have an increased risk of complications, including seroma formation, compared with those with two drains. Generally, reconstructive surgeons can safely opt for a single drain after TE placement.