Seroma in Prosthetic Breast Reconstruction

Jordan, Sumanas W.; Khavanin, Nima; Kim, John Yah Sung

doi:10.1097/01.prs.0000481102.24444.72

Cited by 89 publications

(108 citation statements)

References 109 publications

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“…[2] A closed suction drain in the surgical field can decrease seroma formation and possibly reduces the risk of infection. [3,4] However, prolonged drain duration may increase infection rate due to ascending infection. [5–7] The optimal timing of drain removal after prosthesis-based breast reconstruction is still unclear.…”

Section: Introductionmentioning

confidence: 99%

Risk of infection is associated more with drain duration than daily drainage volume in prosthesis-based breast reconstruction

et al. 2016

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In prosthesis-based breast reconstruction, drains are used to prevent seroma formation and to reduce the risk of infection. However, prolonged drainage increases the risk of ascending infection. Although the volume often accepted for drain removal is ≤30 mL per day, the optimal timing to remove the drain for best clinical outcome remains controversial.We did a retrospective cohort study of 569 patients of prosthesis-based breast reconstruction with infection rate as the outcome variable; drain duration and last daily drainage volume as the main independent variables. Data on age, smoking history, diabetes mellitus history, body mass index, breast weight, tissue expander size, drain size, number of retrieved lymph nodes, tumor size, number of metastatic lymph nodes, tumor stage, mastectomy type, reconstruction type, submuscular implantation, skin defect, operative time, duration of antibiotics use, chemotherapy, and radiotherapy were collected as covariates. Multivariable logistic regression analysis was used to control for confounding.The total infection rate was 5.1% (29/569). The daily drainage volume ≥30 mL/d at the time of drain removal was not found associated with increased infection rate (P = 0.32). Of the various cutoff values of last daily drainage volume, none was found to be a determinant for drain removal where the risk of infection was concerned. By contrast, drain duration over 21 days significantly increased infection rate (P = 0.001). The multivariable logistic regression analysis showed an increase of 76.2% in the infection rate with each additional week of drain retention (P = 0.001). Breast weight also had a significant influence on risk of infection. Chemotherapy and drain size showed borderline effect on risk of infection whereas the last daily drainage volume was not associated with risk of infectionIn summary, our study revealed that drain duration, rather than the last daily drainage volume, significantly affects the infection rate in prosthesis-based breast reconstruction. We recommend that the drain is better removed no longer than 3 weeks postoperatively and can be removed as early as postoperative day 7, even when the drainage is over 30 mL in a 24-hour period.

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Section: Introductionmentioning

confidence: 99%

Risk of infection is associated more with drain duration than daily drainage volume in prosthesis-based breast reconstruction

et al. 2016

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“…Chun et al [1] reported that the use of ADM increased the risk of seroma occurrence by 4.24 times, and of infection by 5.37 times, whereas Parks et al [11] reported that it increased the risk of seroma by almost 2 times. Furthermore, Jordan et al [7] reported that such an increase in the occurrence of seroma multiplied the chance of tissue expander removal by 4.42 times and of infection-induced tissue expander removal by 6.71 times [12]. However, other studies reported no significant association between the use of ADM and seroma formation [13,14].…”

Section: Discussionmentioning

confidence: 96%

“…If a drain is hastily removed before drainage decreases adequately, seroma can occur [7,11,15,16]. Few studies have reported the exact removal time of the drain postoperatively.…”

Section: Discussionmentioning

confidence: 99%

“…Patients clinically presenting with seroma underwent simple aspiration. As a prophylactic antibiotic, 1,000 mg of cephalexin was prescribed 3 times a day for 1 week, and patients were asked to visit the outpatient clinic every 2 days [7,19]. In almost all patients, the seroma resolved with less than 3 aspirations.…”

Section: Discussionmentioning

confidence: 99%

“…It inhibits wound healing, prolongs discomfort and increases the duration of hospital visits, and sometimes leads to subsequent complications such as infection, skin necrosis, and implant failure [1,[3][4][5][6][7].…”

Section: Aaps Archives Of Aesthetic Plastic Surgerymentioning

confidence: 99%

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Comparison of the Amount of Drainage in 3 Acellular Dermal Matrices in Implant-Based Breast Reconstruction: A Retrospective Study

Kim

2017

Arch Aesthetic Plast Surg

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Background Acellular dermal matrix (ADM)-assisted breast reconstruction has gained popularity because it has several advantages. Some studies have reported that the use of ADM was strongly associated with postoperative complications, especially seroma formation. We performed direct-to-implant breast reconstruction using 3 types of human allograft products (CGDerm . The purpose of this study was to obtain information useful for the selection of an ADM product by comparing the amount of collected serum and the maintenance period of the drain. Methods Seventy-three patients with breast cancer who underwent ADM-assisted implant breast reconstruction between March 2011 and January 2016 were included in this study. The patients were divided into 3 groups based on the type of ADM that was used. The demographic characteristics collected were: age, body mass index (BMI), breast reconstruction location, smoking history, axillary dissection, comorbidities (such as hypertension and diabetes mellitus [DM]), breast implant size, breast implant type, amount of ADM, the total amount of serum that was collected in the drain, and the maintenance period of the drain. Results We obtained significant results after adjusting for variables including age, BMI, DM, axillary dissection, ADM amount, and breast implant size. Compared to AlloDerm, MegaDerm showed a significantly smaller amount of total drained serum and a significantly shorter drain maintenance period. Conclusions The use of MegaDerm led to smaller amounts of drained serum and a shorter drain maintenance period than when AlloDerm was used. In contrast, no significant differences were found between CGDerm and AlloDerm, or between CGDerm and MegaDerm.

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Evaluation of a non‐metallic dual‐port expander for intensity modulated proton therapy

McConnell,

Fellows,

Kraus

et al. 2024

J Applied Clin Med Phys

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PurposeTo provide a methodology for characterization of the technical properties of a newly developed non‐metallic tissue expander for intensity modulated proton therapy.MethodsThree tissue expanders (AlloX2‐Pro: plastic‐dual port, AlloX2: metal‐dual port, and Dermaspan: metal‐single port) were deconstructed, CT‐scanned, and modeled in RayStation12A. A 165 MeV single spot was used to create RayStation dose planes, and the integrated depth dose profiles were calculated and the DR90 extracted to predict water equivalent thickness (WET). These predictions were compared to measurements taken with an IBA Giraffe MLIC. Native, water, and fully modelled overrides were compared for the AlloX2 Pro to quantify differences in override choices. Geometric considerations between expanders were compared using a ray‐tracing technique to contour the “no‐fly” zone around metallic components using a clinical, three beam arrangement. Lastly, a planning and evaluation framework was provided using a single plan as an illustration.ResultsThe measured AlloX2‐Pro WET values were within 0.22 cm of RayStation predictions while metallic values ranged from 0.08 to 0.46 cm. Using natively scanned density values for the AlloX2 Pro improved the discrepancy in WET between predicted and measured from −0.22 to −0.09 cm (drain) and from −0.17 to −0.12 cm (injection). The “no‐fly” zone volume of all three beams reduced 95% between the AlloX2‐Pro and Dermaspan, which geometrically allowed more uniform coverage behind the port and reduced need for beam modulation.ConclusionThe beam perturbation of the AlloX2‐Pro is well modeled, but improved agreement with measured WET values was observed when utilizing native densities in calculations. The AlloX2 Pro can support beam arrangements that traverse the ports, which can enable simpler beam geometry and a reduction in dose modulation around the port to promote improved robustness and treatment delivery quality.

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Seroma in Prosthetic Breast Reconstruction

Abstract: Risk, II.

Cited by 89 publications

References 109 publications

Risk of infection is associated more with drain duration than daily drainage volume in prosthesis-based breast reconstruction

Risk of infection is associated more with drain duration than daily drainage volume in prosthesis-based breast reconstruction

Comparison of the Amount of Drainage in 3 Acellular Dermal Matrices in Implant-Based Breast Reconstruction: A Retrospective Study

Evaluation of a non‐metallic dual‐port expander for intensity modulated proton therapy

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