Closed-Suction Drains After Subcutaneous Mastectomy for Gynecomastia: Do They Reduce Complications?

Chao, Jerry; Raveendran, Janani; Maly, Connor; Rogers, Gary F.; Boyajian, Michael J.; Oh, Albert K.

doi:10.1007/s00266-017-0959-z

Cited by 18 publications

(14 citation statements)

References 25 publications

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“…Recurrences of the disorders have not been observed at all. In 156 of the cases, a drain was placed through the axilla for 12-24 hours [30][31][32][33]. In the remaining 366 cases, no drainage was used.…”

Section: Resultsmentioning

confidence: 99%

Gynecomastia and Chest Masculinization: An Updated Comprehensive Reconstructive Algorithm

2021

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Background Gynecomastia is a common finding in males. Clinical aspect varies widely in world populations showing peculiar hallmarks according to different body shapes reflecting personal expectations; therefore, a surgical plan must be tailored on individual basis to all type of patients. Materials and Method A total of 522 patients, treated for bilateral gynecomastia from January 2007 to January 2019, were included and reviewed in this retrospective study. Considering physical status BMI, muscular trophism, hypertrophy of the mammary region, nipple-areola disorder, gland and skin cover consistency, a four-tier classification system has been used to classify the deformity and to assess a surgical plan. In all cases, a subcutaneous mastectomy was performed under direct vision. Results No recurrence of the deformity was observed as well as major complications such as necrosis, and high level of satisfaction was observed in all groups. No breast cancer was found at the histological examinations Operative time ranged from 25 minutes up to 120 minutes and hospitalization time ranged from 1 to 3 days. Conclusion Since the physical status is strictly related to the clinical features of the disorder, a comprehensive classification system and a reconstructive algorithm are proposed.

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Section: Resultsmentioning

confidence: 99%

Gynecomastia and Chest Masculinization: An Updated Comprehensive Reconstructive Algorithm

2021

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“…Unfortunately, anemia in breast cancer patients is frequently seen due to the tumor disease or subsequent chemotherapy. Therefore, patients should be screened for preoperative anemia, and if possible, optimized preoperatively [22][23][24][25]. This is especially relevant, as the rate of anemia increased from approximately 12.5% preoperatively to 78.2% postoperatively in the entire patient population.…”

Section: Discussionmentioning

confidence: 99%

“…Despite the low incidence of postoperative complications after breast reconstructions, our patients often require prolonged hospitalization due to increased drainage output or because of increased (yet not life-threatening) postoperative blood loss [21]. Since the placement of (wound-) drainages (tubes installed within the wound pocket to drain accumulated fluids) is crucial to prevent postoperative seroma formation or to monitor possible secondary bleedings (all of which could compromise surgical outcome), analyzing the amount of fluid promoted daily is essential in breast reconstruction [22][23][24][25]. Several studies have been conducted investigating patient-related factors influencing postoperative drainage fluid volumes and the associated impact on patient's quality of life (QoL) [23,[25][26][27].…”

Section: Introductionmentioning

confidence: 99%

Perioperative Risk Factors for Prolonged Blood Loss and Drainage Fluid Secretion after Breast Reconstruction

Flores

Jaklin

Rohrbacher

et al. 2022

JCM

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Background: Surgical breast reconstruction is an integral part of cancer treatment but must not compromise oncological safety. Patient-dependent risk factors (smoking, BMI, etc.) are said to influence perioperative outcomes and have often been investigated. Here, we analyzed independent perioperative risk factors for increased postoperative blood loss or drainage fluid volume loss and their possible impact. Methods: Patients undergoing breast reconstructions after breast cancer with either tissue expanders, definitive breast implants, or autologous breast reconstruction were analyzed. The collected data on patients’ characteristics, blood, and drainage fluid loss were correlated and statistically investigated. Results: Traditional patient-dependent risk factors did not influence blood loss or drainage volumes. On the contrary, patients with preoperative anemia had significantly higher drainage outputs compared to non-anemic patients (U = 2448.5; p = 0.0012). The administration of low molecular weight heparin showed a tendency of increased drainage output. Similar correlations could be seen in prolonged procedure time, all of which contributed to prolonged hospital stay (τb = 0.371; p < 0.00001). Conclusion: Preoperative anemia is one of the most critical factors influencing postoperative drainage fluid output. Previously assumed patient-dependent risk factors did not affect drainage output. Preoperative anemia must be monitored, and if possible, treated preoperatively to reduce postoperative morbidity.

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“…While this study highlights the importance of a pelvic closed suction drain in APR surgery, there are added costs for the drains and additional clinic visits, increased patient discomfort and anxiety, and the drains act as a nidus for bacterial colonization. 15 , 22 What is less clear, however, is whether this bacterial colonization results in an increased rate of infections. 15 , 16 , 17 , 18 It is routine at this institution and for many practitioners to prescribe prophylactic antibiotics against gram-positive bacteria while drains are in, but the literature is unclear on this practice.…”

Section: Discussionmentioning

confidence: 99%

Ten-Year experience with vertical rectus abdominis myocutaneous flap for reconstruction of abdominoperineal resection defects

et al. 2021

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Purpose We evaluate outcomes of our single center using vertical rectus abdominis myocutaneous (VRAM) flaps for reconstruction after abdominoperineal resection (APR). Our goal was to analyze factors that may affect perineal wound healing, a problematic complication with APR reconstructions due to location and high frequency of neoadjuvant chemoradiation. Methods This single-center, retrospective study analyzed all VRAM flap perineal reconstruction patients after APR defect over a 10-year period (from July 2008 to June 2018). Outcome measures focused on factors that may affect perineal wound healing complication rates: cancer stage (I/II vs III/IV), neoadjuvant chemoradiation, surgeon's years in practice (<5 years vs >5 years), and pelvic closed suction drain use. Results Twenty-eight patients met inclusion criteria. The overall major perineal wound complication rate was 14.3% (4 patients). Lack of perioperative closed suction pelvic drain use was associated with a significantly higher rate of major perineal wound complications (28.6% vs 0% and p = 0.031). All four major wound complications occurred in patients who did not have a pelvic drain. The major perineal wound complication rate for patients who underwent neoadjuvant chemoradiation was 22% vs 0% with no neoadjuvant chemoradiation ( p = 0.107). Conclusion While our cohort represents a relatively small single-center study, our 14.3% rate of major perineal wound complications is consistent with previous studies in the literature. Our findings show that perioperative pelvic closed suction drain use is associated with a lower rate of perineal wound complications. While neoadjuvant chemoradiation trended toward a higher incidence of perineal wound complications, it did not reach statistical significance.

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Closed-Suction Drains After Subcutaneous Mastectomy for Gynecomastia: Do They Reduce Complications?

Abstract: 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 Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Cited by 18 publications

References 25 publications

Gynecomastia and Chest Masculinization: An Updated Comprehensive Reconstructive Algorithm

Gynecomastia and Chest Masculinization: An Updated Comprehensive Reconstructive Algorithm

Perioperative Risk Factors for Prolonged Blood Loss and Drainage Fluid Secretion after Breast Reconstruction

Ten-Year experience with vertical rectus abdominis myocutaneous flap for reconstruction of abdominoperineal resection defects

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