Single versus Double Drainage for Immediate Two-Stage Implant-Based Breast Reconstruction: A Propensity Score-Matched Analysis

Joseph M Escandón; Alejandra Aristizábal; Howard N Langstein; Jose G Christiano; Jessica C Gooch; Peter A Prieto; Kristin A Skinner; Anna Weiss; Oscar J Manrique

doi:10.1007/s00266-023-03800-6

Single versus Double Drainage for Immediate Two-Stage Implant-Based Breast Reconstruction: A Propensity Score-Matched Analysis

Aesthetic Plast Surg. 2024 Jan 12. doi: 10.1007/s00266-023-03800-6. Online ahead of print.

Authors

Joseph M Escandón¹, Alejandra Aristizábal¹, Howard N Langstein¹, Jose G Christiano¹, Jessica C Gooch², Peter A Prieto², Kristin A Skinner², Anna Weiss², Oscar J Manrique³

Affiliations

¹ Division of Plastic and Reconstructive Surgery, Strong Memorial Hospital, University of Rochester Medical Center, Rochester, NY, USA.
² Division of Surgical Oncology, Department of Surgery, Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY, USA.
³ Division of Plastic and Reconstructive Surgery, Strong Memorial Hospital, University of Rochester Medical Center, Rochester, NY, USA. oscarj.manrique@gmail.com.

PMID: 38216789
DOI: 10.1007/s00266-023-03800-6

Abstract

Background: Reports evaluating plastic surgeons' practices indicate there are conflicting trends regarding the use of one or two drains for implant-based breast reconstruction (IBBR). Our study aimed to perform a matched cohort analysis to examine the postoperative outcomes and complications of immediate IBBR with tissue expander (TE) using two drains versus a single drain.

Methods: A propensity score-matched analysis (nearest neighbor, 1:1 matching) of immediate reconstructions using two versus one drain was conducted. Female patients undergoing immediate two-stage IBBR with TEs between January 2011 and May 2021 were included. The covariables were as follows: BMI, mastectomy weight, lymph node surgery, TE surface, plane of reconstruction, use of acellular dermal matrix products, fluorescence imaging use, and intraoperative TE volume.

Results: After matching using propensity scores, 192 reconstructions were included in the final analysis: 96 in each group. The rate of 30-day complications and overall complications during the first phase of IBBR were comparable between groups. The time for drain removal, time to initiate and finalize expansions, and time for TE-to-implant exchange were comparable between groups. Diabetes (OR 3.74, p = 0.025) and an increased estimated blood loss (OR 1.004, p = 0.01) were the only independent predictors for seroma formation.

Conclusion: In this matched cohort analysis evaluating the role of one versus two drains for two-stage IBBR, we found a comparable rate of complications and surgical outcomes between the two cohorts. Using two drains for immediate IBBR needs to be tailored depending on intraoperative findings.

Level of evidence iii: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Keywords: Breast implantation [mesh]; Female [mesh]; Postoperative complications [mesh]; Tissue expansion devices [mesh]; Treatment outcome [mesh].