No drains, no problem: A description of tissue expander breast reconstruction omitting traditional closed suction...

Drainless tissue expansion has been reported possible, but lacking is a description of the associated demands and implementation. This study describes expectations regarding follow-up frequency, aspiration volumes, and how experiences differ based on reconstruction timing.

A retrospective review was performed of patients who underwent prepectoral dual-port tissue expander (TE) placement from February 2023 to December 2024. Medical history, intraoperative details, complications, and periprosthetic aspiration volumes were collected.

Sixty-six patients making up 94 breasts were included. Average days to point of no aspiration was 21.7 (SD 9.2 days), with an average of 5.5 aspirations (SD 1.9 aspirations). After the first 2 aspirations, percentage of breasts requiring aspirations dropped; 85.1% of breasts required at least 4 aspirations, 44.7% required at least 6%, and 7.4% required at least 8. Less than 50% of breasts required aspirations after 20 days, and less than 20% required aspirations after 30 days. Average drainage per breast during the first three aspirations was 141.4, 133.0, and 123.6 mLs, respectively, and tapered with subsequent aspirations. Compared to early interval-staged reconstruction, immediate reconstruction had greater total drainage (350.7 mLs vs 816.2 mLs, p<0.001) and average drainage per aspiration (80.7 vs 128.4 mLs, p<0.001).

Drainless breast reconstruction is possible with an equivalent safety profile to the standard approach utilizing drains. This study provides a better understanding of the expected frequency of aspiration sessions and volumes removed during visits. Further, the results provide support for its integration in TE reconstruction with a low rate of infection.