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

Abstract

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

Methods: We retrospectively analyzed breast expander-to-implant exchanges performed from 2018 to 2023 and compared complication rates between patients treated with and without drains. Patients' demographic, disease, treatment, and outcome data were recorded. Genetic 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 versus the no-drain group (12% vs. 4.7%, 2.5% vs. 0.3%, and 8.5% vs. 2.6%, respectively, p < 0.05). This was particularly evident in the prepectoral plane, where overall complication (11% vs. 4.3%, p = 0.014), implant exposure (2.2% vs. 0%, p = 0.047), and implant explantation (6.7% vs. 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.

Conclusion: Surgical drains do not protect against adverse outcomes in the second stage of IBBR, 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.