Top

Published in:

27-06-2023 | Seroma | Original Paper

Factors contributing to prolonged drain duration in prepectoral staged implant-based breast reconstruction

Authors: Kometh Thawanyarat, Jennifer K. Shah, Gina Eggert, Mallory Rowley, Trudy Kim, Pooja S. Yesantharao, Elizabeth Turner, Brian Thornton, Rahim Nazerali

Published in: European Journal of Plastic Surgery | Issue 6/2023

Abstract

Background

Current literature demonstrates that factors contributing to prolonged drain duration in the subpectoral implant-based and autologous populations include older age, higher body mass index (BMI), history of neoadjuvant chemotherapy, textured tissue expanders, large volumes of initial tissue expander inflation, use of acellular dermal matrix, hypertension, and reoperation. We aim to examine factors contributing to prolonged drain duration in the prepectoral staged implant-based breast reconstruction population.

Methods

This was a retrospective investigation of 336 patients who underwent prepectoral staged implant-based breast reconstruction between 2018 and 2021 at a single institution. Prolonged drain duration was defined as patients whose drain duration period was at the 75th percentile or above. Patient demographics, comorbidities, medical histories, perioperative variables, and complication rates were recorded. Chi-square and multivariable regression tests were performed to evaluate variables that would impact prolonged drain duration and post-operative complications.

Results

Of 336 patients (mean age 49.30 ± 10.73), 88 experienced prolonged drain duration (18 days). Higher BMI (obese category) (p = 0.003) was the only significant predictor of prolonged drain duration.

Conclusions

In patients undergoing prepectoral staged implant-based reconstruction, BMI above the obese threshold increases the risk of prolonged drain duration. In contrast to prior studies performed in autologous reconstruction and subpectoral reconstruction, other demographic and perioperative factors were not significant predictors of prolonged drain. Given the increasing prevalence and preference for prepectoral breast reconstruction, this study can be used to guide postoperative management concerning drain removal and follow-up parameters.

Level of evidence: Level III, Risk/Prognostic

Albornoz CR, Bach PB, Mehrara BJ et al (2013) A paradigm shift in U.S. Breast reconstruction: increasing implant rates. Plast Reconstr Surg 131(1):15–23. https://doi.org/10.1097/PRS.0b013e3182729cdeCrossRefPubMed

Walia GS, Aston J, Bello R et al (2018) Prepectoral versus subpectoral tissue expander placement: a clinical and quality of life outcomes study. Plast Reconstr Surg Glob Open 6(4):e1731. https://doi.org/10.1097/GOX.0000000000001731. (Published 2018 Apr 20)CrossRefPubMedPubMedCentral

Yang JY, Kim CW, Lee JW, Kim SK, Lee SA, Hwang E (2019) Considerations for patient selection: prepectoral versus subpectoral implant-based breast reconstruction. Arch Plast Surg 46(6):550–557. https://doi.org/10.5999/aps.2019.00353CrossRefPubMedPubMedCentral

Murray JD, Elwood ET, Jones GE, Barrick R, Feng J (2009) Decreasing expander breast infection: a new drain care protocol. Can J Plast Surg 17(1):17–21CrossRefPubMedPubMedCentral

Xue DQ, Qian C, Yang L, Wang XF (2012) Risk factors for surgical site infections after breast surgery: a systematic review and meta-analysis. Eur J Surg Oncol 38(5):375–381. https://doi.org/10.1016/j.ejso.2012.02.179CrossRefPubMed

Lee KT, Hong SH, Jeon BJ, Pyon JK, Mun GH, Bang SI (2019) Predictors for prolonged drainage following tissue expander-based breast reconstruction. Plast Reconstr Surg 144(1):9e–17e. https://doi.org/10.1097/PRS.0000000000005697CrossRefPubMed

Edwards BL, Stukenborg GJ, Brenin DR, Schroen AT (2014) Use of prophylactic postoperative antibiotics during surgical drain presence following mastectomy. Ann Surg Oncol 21(10):3249–3255. https://doi.org/10.1245/s10434-014-3960-7CrossRefPubMedPubMedCentral

Chen CF, Lin SF, Hung CF, Chou P (2016) Risk of infection is associated more with drain duration than daily drainage volume in prosthesis-based breast reconstruction: a cohort study. Medicine (Baltimore) 95(49):e5605. https://doi.org/10.1097/MD.0000000000005605CrossRefPubMed

Dinis J, Allam O, Junn A, et al (2021) Predictors for prolonged drain use following autologous breast reconstruction [published online ahead of print, 2021 Jul 20]. J Reconstr Microsurg. https://doi.org/10.1055/s-0041-1731765

10.

Felippe WA, Werneck GL, Santoro-Lopes G (2007) Surgical site infection among women discharged with a drain in situ after breast cancer surgery. World J Surg 31(12):2293–2301. https://doi.org/10.1007/s00268-007-9248-3CrossRefPubMed

11.

Brahmbhatt RD, Huebner M, Scow JS et al (2012) National practice patterns in preoperative and postoperative antibiotic prophylaxis in breast procedures requiring drains: survey of the American Society of Breast Surgeons. Ann Surg Oncol 19(10):3205–3211. https://doi.org/10.1245/s10434-012-2477-1CrossRefPubMedPubMedCentral

12.

Khansa I, Hendrick RG Jr, Shore A, Meyerson J, Yang M, Boehmler JH IV (2014) Breast reconstruction with tissue expanders: implementation of a standardized best-practices protocol to reduce infection rates. Plast Reconstr Surg 134:11–18CrossRefPubMed

13.

Phillips BT, Wang ED, Mirrer J et al (2011) Current practice among plastic surgeons of antibiotic prophylaxis and closed- suction drains in breast reconstruction: experience, evi- dence, and implications for postoperative care. Ann Plast Surg 66:460–465CrossRefPubMed

14.

Antoniak K, Hansdorfer-Korzon R, Mrugacz M, Zorena K (2021) Adipose tissue and biological factors. Possible Link between Lymphatic System Dysfunction and Obesity. Metabolites 11(9):617. https://doi.org/10.3390/metabo11090617. (Published 2021 Sep 11)CrossRefPubMedPubMedCentral

15.

García Nores GD, Cuzzone DA, Albano NJ et al (2016) Obesity but not high-fat diet impairs lymphatic function. Int J Obes (Lond) 40(10):1582–1590. https://doi.org/10.1038/ijo.2016.96CrossRefPubMed

16.

Stapleton PA, James ME, Goodwill AG, Frisbee JC (2008) Obesity and vascular dysfunction. Pathophysiology 15(2):79–89. https://doi.org/10.1016/j.pathophys.2008.04.007CrossRefPubMed

17.

Haddock N, Levine J (2010) Breast reconstruction with implants, tissue expanders and AlloDerm: predicting volume and maximizing the skin envelope in skin sparing mastectomies. Breast J 16(1):14–19. https://doi.org/10.1111/j.1524-4741.2009.00866.xCrossRefPubMed

18.

Suga H, Shiraishi T, Shibasaki Y, Takushima A, Harii K (2016) Predictive factors for drainage volume after expander-based breast reconstruction. Plast Reconstr Surg Global Open 4(6):e727. https://doi.org/10.1097/GOX.0000000000000752CrossRef

Title: Factors contributing to prolonged drain duration in prepectoral staged implant-based breast reconstruction
Authors: Kometh Thawanyarat
Jennifer K. Shah
Gina Eggert
Mallory Rowley
Trudy Kim
Pooja S. Yesantharao
Elizabeth Turner
Brian Thornton
Rahim Nazerali
Publication date: 27-06-2023
Publisher: Springer Berlin Heidelberg
Keywords: Seroma
Mastectomy
Published in: European Journal of Plastic Surgery / Issue 6/2023
Print ISSN: 0930-343X
Electronic ISSN: 1435-0130
DOI: https://doi.org/10.1007/s00238-023-02092-y

2024 ASCO Annual Meeting

Springer Medicine

Factors contributing to prolonged drain duration in prepectoral staged implant-based breast reconstruction

Abstract

Background

Methods

Results

Conclusions

2024 ASCO Annual Meeting

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 6/2023

Thin-ALT and SCIP flaps versus standard ALT for lower extremity reconstruction: how thick is the evidence?

Treatment of retracted, postsurgical scars and reduction of locoregional edema using a combined three-dimensional approach of liposuction lipofilling, dissecting cannulas, and suspension sutures

Reconstructive procedure for treatment of trochanteric pressure ulcers in spinal-cord-injured patients

The use of NovoSorb™ Biodegradable Temporising Matrix (BTM™) in the reconstruction of complex soft tissue defects — an oncological, aesthetic, and practical solution

The use of gluteus maximus to restore the function of the pelvic diaphragm in the reconstruction of the pelvic outlet after abdomino-perineal resection: a case series

A 5-year multicenter retrospective study on Motiva Ergonomix® breast implants: Minimizing complications and maximizing results