Drain Use and Complications after Breast Reduction in a 5-Academic Institution Cohort

More than 70,000 reduction mammaplasties were performed in 2022. Previous studies have suggested equivalent overall complication rates with or without intraoperative drains but have been inadequately powered to assess individual outcomes. The authors assessed whether use of drains was associated with a lower risk of complications after breast reduction in a multi-institutional cohort study.

A retrospective multi-institutional cohort of 2488 patients undergoing breast reduction with and without drains was evaluated. Demographic and perioperative data were compared between groups and the impact of intraoperative drain placement on postoperative outcomes was evaluated.

Drains were used in 1163 patients (46.7%) and 1325 cases (53.3%) were performed without drains. Patients with higher body mass index (BMI), greater preoperative breast anthropometrics, greater resection weight, multiple medical comorbidities, superior pedicle, or concomitant procedures ( P < 0.05) were more likely to have drains placed. Despite these preoperative differences, there was no significant difference in overall complication rate (30.7% versus 27.1%), wound dehiscence (12.3% versus 14.2%), seroma (1.8% versus 2.0%), hematoma (2.9 versus 3.7%), infection (9.7% versus 7.8%), or need for revision surgery (11% versus 10.2%). However, elevated BMI was significantly associated with overall complications, seroma, and wound dehiscence (all P < 0.01), and hematologic disease was associated with seroma ( P < 0.01).

Drain placement was not associated with improved outcomes after breast reduction surgery in a large multicenter retrospective cohort. Surgeons were more likely to use drains in patients with a higher BMI, larger breasts, or greater medical complexity, with outcomes similar to those of the cohort without drains.