Analysis of factors that affect drainage volume after expander-based breast reconstruction

Lim, Yoon Min; Lew, Dae Hyun; Roh, Tai Suk; Song, Seung Yong

doi:10.5999/aps.2019.00283

Cited by 14 publications

(16 citation statements)

References 24 publications

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“…Age showed a strong correlation with the total drainage volume in the univariate analysis (P = 0.011). A previous study from our institution reported the same result; older patients had a larger drainage volume 10 . The specimen weight also demonstrated a significant correlation with the total drainage volume.…”

Section: Discussionsupporting

confidence: 81%

“…The aforementioned studies excluded patients who underwent reconstructive surgery. In fact, previous studies have already shown that the type or size of tissue expander used can affect the amount of drainage volume postoperatively 8 9 10 , which provides context for the finding that the total drainage volume in our study was larger than all volumes reported in previous studies. Another aspect of how our study differed from other previous reports was in its patient selection; most studies have included all patients who underwent mastectomy, regardless of the type of breast reconstruction that followed.…”

Section: Discussionsupporting

confidence: 77%

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The effect of early arm exercise on drainage volume after total mastectomy and tissue expander insertion in breast cancer patients: a prospective study

et al. 2021

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Background In prosthesis-based breast reconstruction patients, the drain tends to be kept in place longer than in patients who undergo only mastectomy. Postoperative arm exercise also increases the drainage volume. However, to preserve shoulder function, early exercise is recommended. In this study, we investigated the effect of early exercise on the total drainage volume and drain duration in these patients.Methods We designed a prospective randomized trial involving 56 patients who underwent immediate breast reconstruction following mastectomy using tissue expanders. In each group, the patients were randomized either to perform early arm exercises using specific shoulder movement guidelines 2 days after surgery or to restrict arm movement above the shoulder height until drain removal. The drain duration and the total amount of drainage were the primary endpoints.Results There were no significant differences in age, height, weight, body mass index, or mastectomy specimen weight between the two groups. The total amount of drainage was 1,497 mL in the early exercise group and 1,336 mL in the exercise restriction group. The duration until complete removal of the drains was 19.71 days in the early exercise group and 17.11 days in the exercise restriction group.Conclusions Exercise restriction after breast reconstruction did not lead to a significant difference in the drainage volume or the average time until drain removal. Thus, early exercise is recommended for improved shoulder mobility postoperatively. More long-term studies are needed to determine the effect of early exercise on shoulder mobility in prosthesis-based breast reconstruction patients.

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Section: Discussionsupporting

confidence: 81%

Section: Discussionsupporting

confidence: 77%

The effect of early arm exercise on drainage volume after total mastectomy and tissue expander insertion in breast cancer patients: a prospective study

et al. 2021

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Section: Discussionmentioning

confidence: 99%

“…In addition, we found that volume of tissue expansion was not significantly associated with time until drain removal, which differs from the literature in that Lim et al found a strong correlation between tissue expander volume and duration of drain placement. 19 There is no universal set of rules to aid surgeons' decisions on whether to pursue pre-pectoral versus dual plane reconstruction. 4 Given that no consensus exists in the literature, the surgeons in this study similarly did not follow an algorithm for determining surgical course but rather determined course based on shared decision-making with the patient.…”

Section: Prs Global Open • 2022mentioning

confidence: 99%

Drain Removal Time in Pre-pectoral versus Dual Plane Prosthetic Breast Reconstruction following Nipple-sparing Mastectomy

Moriarty

Baker

Hart

et al. 2022

Plastic and Reconstructive Surgery - Global Open

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Background: Pre-pectoral prosthetic breast reconstruction following nipple-sparing mastectomy (NSM) has become a popular approach compared with the dual plane technique. Our objective was to determine if there was a difference in time to postoperative breast drain removal in direct-to-implant or tissue expander reconstruction following NSM when comparing pre-pectoral with dual plane technique. Methods: A total of 200 patients (335 breasts) received NSM followed by implant or expander reconstruction at our institution between the years 2009 and 2020. Direct-to-implant reconstruction had 113 pre-pectoral versus 67 dual plane, and tissue expander reconstruction had six pre-pectoral versus 149 dual plane. Our analysis included age at mastectomy, body mass index, history of preoperative breast radiation, and smoking history. Case complications included seroma or hematoma, breast or axillary infection requiring antibiotics or operative washout, device replacement due to extrusion or infection, skin necrosis, and capsular contracture. Statistical analysis was completed with Pearson chi-square test, Fisher exact test, and the two-sample T-test using IBM SPSS Statistics 24.0 (IBM Corp., Armonk, N.Y.). Results:The average time until breast drain removal in dual plane implant patients was significantly less than in pre-pectoral implant patients (9.42 versus 14.01 days). The average time until breast drain removal in dual plane expander patients was significantly less than in pre-pectoral expander patients (11.47 versus 20.30 days). Conclusion:In both implant and expander reconstruction following NSM, patients receiving dual plane device placement had a shorter postoperative time until breast drain removal when compared with patients receiving pre-pectoral device placement.

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“…Factors influencing the time until removal of breast drains have been described in implant-based reconstruction, which remains the most frequently utilized breast reconstruction modality. [4][5][6][7] However, no similar study to date has been performed for autologous reconstruction. The timeliness of this study is compounded by recent interest in utilizing progressive barbed tension sutures for a drain free donor site closure.…”

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confidence: 99%

Predictors for Prolonged Drain Use Following Autologous Breast Reconstruction

Dinis

Allam

Junn

et al. 2021

J Reconstr Microsurg

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Background Surgical drains are routinely used following autologous reconstruction, but are often cited as the leading cause of peri-operative discomfort. This study defined routine drain use duration and assessed the risk factors for prolonged breast and abdominal drain use during microvascular breast reconstruction, measures which have never previously been defined. Methods Patients who underwent an abdominal microvascular free flap were included. Demographics, comorbidities, and operation-related characteristics were retrospectively collected in a prospectively maintained database. Statistical analysis utilized chi-square independent t-test, and linear regression analyses. Results One hundred forty-nine patients comprising 233 breast flaps were included. Average breast and abdominal drain duration were 12.9 ± 3.9 and 17.7 ± 8.2 days, respectively. Prolonged breast and abdominal drain duration were defined as drain use beyond the 75th percentile at 14 and 19 days, respectively. Multivariable regression revealed hypertension was associated with an increased breast drain duration by 1.4 days (p = 0.024), axillary dissection with 1.7 days (p = 0.026), African-American race with 3.1 days (p < 0.001), Hispanic race with 1.6 days (p = 0.029), return to the OR with 3.2 days (p = 0.004), and each point increase in BMI with 0.1 days (p = 0.028). For abdominal drains, each point increase in BMI was associated with an increased abdominal drain duration by 0.3 days (p = 0.011), infection with 14.4 days (p < 0.001), and return to the OR with 5.7 days (p = 0.007). Conclusion Elevated BMI, hypertension, and axillary dissection increase risk for prolonged breast drain requirement in autologous reconstruction. African-American and Hispanic populations experience prolonged breast drain requirement after controlling for other factors, warranting further study.

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Analysis of factors that affect drainage volume after expander-based breast reconstruction

Cited by 14 publications

References 24 publications

The effect of early arm exercise on drainage volume after total mastectomy and tissue expander insertion in breast cancer patients: a prospective study

The effect of early arm exercise on drainage volume after total mastectomy and tissue expander insertion in breast cancer patients: a prospective study

Drain Removal Time in Pre-pectoral versus Dual Plane Prosthetic Breast Reconstruction following Nipple-sparing Mastectomy

Predictors for Prolonged Drain Use Following Autologous Breast Reconstruction

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