Prophylactic Drain Use in Breast Expander-to-Implant Exchange: Necessity or Nuisance?

IF 3.4 2区医学 Q1 SURGERY Plastic and reconstructive surgery Pub Date : 2025-11-01 Epub Date: 2025-03-18 DOI:10.1097/PRS.0000000000012101

Rami Elmorsi, Jose E Barrera, Carrie Chu, Mark W Clemens, Patrick B Garvey, Matthew M Hanasono, J Bryce Olenczak, Alexander F Mericli

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Abstract

Background: Although drain placement is widely used during the tissue expander (TE) stage of implant-based breast reconstruction, it is unclear whether surgical drains are necessary at the TE-to-implant exchange stage. The authors sought to define clinical scenarios in which drains should and should not be used.

Methods: The authors retrospectively analyzed breast TE-to-implant exchanges performed from 2018 to 2023 and compared complication rates between patients treated with and without drains. Patient demographic, disease, treatment, and outcome data were recorded. Propensity score matching was used to mitigate selection bias. Multivariable binary logistic regression identified significant predictors of complications.

Results: In unmatched comparisons, rates of overall complications, implant exposure, and implant explantation were significantly higher in the drain group compared with the no-drain group (12% versus 4.7%, 2.5% versus 0.3%, and 8.5% versus 2.6%, respectively; P < 0.05). This was particularly evident in the prepectoral plane, where overall complication (11% versus 4.3%; P = 0.014), implant exposure (2.2% versus 0%; P = 0.047), and implant explantation (6.7% versus 2.2%; P = 0.041) rates were significantly higher with drains. However, propensity score-matched comparisons, stratification by concomitant ancillary procedures, and multivariable logistic regression showed that drain placement was neither predictive of nor protective against postoperative complications.

Conclusions: Surgical drains do not protect against adverse outcomes in the second stage of implant-based breast reconstruction, even with ancillary procedures, and may contribute to higher complication rates, particularly in the prepectoral plane. However, patients with a heavy dissection burden, extensive capsular manipulation or resection, or comorbidities may benefit from drain placement.

Clinical question/level of evidence: Therapeutic, III.

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在乳房扩张器植入物交换术中预防性引流：必要还是麻烦？

导言：尽管在植入式乳房重建（IBBR）的组织扩张器阶段广泛使用引流管放置，但在扩张器-植入物交换阶段是否需要手术引流尚不清楚。我们试图确定临床场景中应该和不应该使用引流管。方法：回顾性分析2018年至2023年进行的乳房扩张器-植入物置换手术，并比较有引流管和无引流管患者的并发症发生率。记录患者的人口统计学、疾病、治疗和结局数据。采用遗传倾向评分匹配来减轻选择偏差。多变量二元逻辑回归确定了并发症的显著预测因素。结果：在不匹配的比较中，引流组的总并发症、种植体暴露和种植体外植率明显高于无引流组（分别为12% vs. 4.7%、2.5% vs. 0.3%和8.5% vs. 2.6%, p < 0.05）。这在胸前平面尤为明显，引流管的总并发症（11% vs. 4.3%, p = 0.014）、植入物暴露（2.2% vs. 0%, p = 0.047）和植入物外植（6.7% vs. 2.2%, p = 0.041）率明显更高。然而，倾向评分匹配比较、伴随辅助手术分层和多变量逻辑回归显示，引流管放置既不能预测也不能预防术后并发症。结论：手术引流不能预防IBBR第二阶段的不良后果，即使有辅助手术，也可能导致更高的并发症发生率，特别是在前膀胱平面。然而，有沉重的解剖负担，包膜操作或切除广泛，或合并症的患者可能受益于引流管放置。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Plastic and reconstructive surgery 医学-外科

CiteScore

5.00

自引率

13.90%

发文量

1436

审稿时长

1.5 months

期刊介绍： For more than 70 years Plastic and Reconstructive Surgery® has been the one consistently excellent reference for every specialist who uses plastic surgery techniques or works in conjunction with a plastic surgeon. Plastic and Reconstructive Surgery® , the official journal of the American Society of Plastic Surgeons, is a benefit of Society membership, and is also available on a subscription basis. Plastic and Reconstructive Surgery® brings subscribers up-to-the-minute reports on the latest techniques and follow-up for all areas of plastic and reconstructive surgery, including breast reconstruction, experimental studies, maxillofacial reconstruction, hand and microsurgery, burn repair, cosmetic surgery, as well as news on medicolegal issues. The cosmetic section provides expanded coverage on new procedures and techniques and offers more cosmetic-specific content than any other journal. All subscribers enjoy full access to the Journal''s website, which features broadcast quality videos of reconstructive and cosmetic procedures, podcasts, comprehensive article archives dating to 1946, and additional benefits offered by the newly-redesigned website.