J Reconstr Microsurg 2022; 38(02): 160-167
DOI: 10.1055/s-0041-1731765
Original Article

Predictors for Prolonged Drain Use Following Autologous Breast Reconstruction

Jacob Dinis*
1   Department of Surgery, Section of Plastic and Reconstructive Surgery, Yale University School of Medicine, New Haven, Connecticut
,
Omar Allam*
1   Department of Surgery, Section of Plastic and Reconstructive Surgery, Yale University School of Medicine, New Haven, Connecticut
,
Alexandra Junn
1   Department of Surgery, Section of Plastic and Reconstructive Surgery, Yale University School of Medicine, New Haven, Connecticut
,
Kitae Eric Park
1   Department of Surgery, Section of Plastic and Reconstructive Surgery, Yale University School of Medicine, New Haven, Connecticut
,
1   Department of Surgery, Section of Plastic and Reconstructive Surgery, Yale University School of Medicine, New Haven, Connecticut
,
Rema Shah
1   Department of Surgery, Section of Plastic and Reconstructive Surgery, Yale University School of Medicine, New Haven, Connecticut
,
Tomer Avraham
1   Department of Surgery, Section of Plastic and Reconstructive Surgery, Yale University School of Medicine, New Haven, Connecticut
,
Michael Alperovich
1   Department of Surgery, Section of Plastic and Reconstructive Surgery, Yale University School of Medicine, New Haven, Connecticut
› Author Affiliations
Funding This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Abstract

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.

* Co-first authors.




Publication History

Received: 09 February 2021

Accepted: 12 May 2021

Article published online:
20 July 2021

© 2021. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 
  • References

  • 1 Momoh AO, Griffith KA, Hawley ST. et al. Patterns and Correlates of Knowledge, Communication, and Receipt of Breast Reconstruction in a Modern Population-Based Cohort of Patients with Breast Cancer. Plast Reconstr Surg 2019; 144 (02) 303-313
  • 2 Santosa KB, Qi J, Kim HM, Hamill JB, Wilkins EG, Pusic AL. Long-term Patient-Reported Outcomes in Postmastectomy Breast Reconstruction. JAMA Surg 2018; 153 (10) 891-899
  • 3 Klement KA, Hijjawi JB, LoGiudice JA, Alghoul M, Omesiete-Adejare P. Microsurgical Breast Reconstruction in the Obese: A Better Option Than Tissue Expander/Implant Reconstruction?. Plast Reconstr Surg 2019; 144 (03) 539-546
  • 4 Panchal H, Matros E. Current Trends in Postmastectomy Breast Reconstruction. Plast Reconstr Surg 2017; 140 (5S Advances in Breast Reconstruction): 7S-13S
  • 5 Lee KT, Hong SH, Jeon BJ, Pyon JK, Mun GH, Bang SI. Predictors for Prolonged Drainage following Tissue Expander-Based Breast Reconstruction. Plast Reconstr Surg 2019; 144 (01) 9e-17e
  • 6 Lim YM, Lew DH, Roh TS, Song SY. Analysis of factors that affect drainage volume after expander-based breast reconstruction. Arch Plast Surg 2020; 47 (01) 33-41
  • 7 Suga H, Shiraishi T, Shibasaki Y, Takushima A, Harii K. Predictive Factors for Drainage Volume after Expander-based Breast Reconstruction. Plast Reconstr Surg Glob Open 2016; 4 (06) e727
  • 8 Thacoor A, Kanapathy M, Torres-Grau J, Chana J. Deep inferior epigastric perforator (DIEP) flap: Impact of drain free donor abdominal site on long term patient outcomes and duration of inpatient stay. J Plast Reconstr Aesthet Surg 2018; 71 (08) 1103-1107
  • 9 Nagarkar P, Lakhiani C, Cheng A, Lee M, Teotia S, Saint-Cyr M. No-drain DIEP Flap Donor-site Closure Using Barbed Progressive Tension Sutures. Plast Reconstr Surg Glob Open 2016; 4 (04) e672
  • 10 Mohan AT, Rammos CK, Gaba P. et al. Modified aesthetic abdominoplasty approach in perforator free-flap breast reconstruction: Impact of drain free donor site on patient outcomes. J Plast Reconstr Aesthet Surg 2015; 68 (06) 800-809
  • 11 Vos H, Smeets A, Neven P, Laenen A, Vandezande L, Nevelsteen I. Early drain removal improves quality of life and clinical outcomes in patients with breast cancer - Results from a randomised controlled trial. Eur J Oncol Nurs 2018; 36: 112-118
  • 12 Chen CF, Lin SF, Hung CF, Chou P. Risk of infection is associated more with drain duration than daily drainage volume in prosthesis-based breast reconstruction: A cohort study. Medicine (Baltimore) 2016; 95 (49) e5605
  • 13 Ahmed AA, Mooar PA, Kleiner M, Torg JS, Miyamoto CT. Hypertensive patients show delayed wound healing following total hip arthroplasty. PLoS One 2011; 6 (08) e23224
  • 14 Rutkowski JM, Davis KE, Scherer PE. Mechanisms of obesity and related pathologies: the macro- and microcirculation of adipose tissue. FEBS J 2009; 276 (20) 5738-5746
  • 15 Stapleton PA, James ME, Goodwill AG, Frisbee JC. Obesity and vascular dysfunction. Pathophysiology 2008; 15 (02) 79-89
  • 16 Dinh QN, Drummond GR, Sobey CG, Chrissobolis S. Roles of inflammation, oxidative stress, and vascular dysfunction in hypertension. BioMed Res Int 2014; 2014: 406960
  • 17 Bao P, Kodra A, Tomic-Canic M, Golinko MS, Ehrlich HP, Brem H. The role of vascular endothelial growth factor in wound healing. J Surg Res 2009; 153 (02) 347-358
  • 18 Dormandy JA. Pathophysiology of venous leg ulceration--an update. Angiology 1997; 48 (01) 71-75
  • 19 Shamberger RC, Devereux DF, Brennan MF. The effect of chemotherapeutic agents on wound healing. Int Adv Surg Oncol 1981; 4: 15-58
  • 20 Utley JR, Thomason ME, Wallace DJ. et al. Preoperative correlates of impaired wound healing after saphenous vein excision. J Thorac Cardiovasc Surg 1989; 98 (01) 147-149
  • 21 Kiefer FN, Neysari S, Humar R, Li W, Munk VC, Battegay EJ. Hypertension and angiogenesis. Curr Pharm Des 2003; 9 (21) 1733-1744
  • 22 O'Brien KB, Vogel P, Duan S. et al. Impaired wound healing predisposes obese mice to severe influenza virus infection. J Infect Dis 2012; 205 (02) 252-261
  • 23 Gwyn K, Bondy ML, Cohen DS. et al. Racial differences in diagnosis, treatment, and clinical delays in a population-based study of patients with newly diagnosed breast carcinoma. Cancer 2004; 100 (08) 1595-1604
  • 24 Smith C. African Americans and the medical establishment. Mt Sinai J Med 1999; 66 (04) 280-281
  • 25 Kim SH, Ferrante J, Won BR, Hameed M. Barriers to adequate follow-up during adjuvant therapy may be important factors in the worse outcome for Black women after breast cancer treatment. World J Surg Oncol 2008; 6 (01) 26
  • 26 Petrek JA, Peters MM, Nori S, Knauer C, Kinne DW, Rogatko A. Axillary lymphadenectomy. A prospective, randomized trial of 13 factors influencing drainage, including early or delayed arm mobilization. Arch Surg 1990; 125 (03) 378-382
  • 27 Allam O, Park KE, Chandler L. et al. The impact of radiation on lymphedema: a review of the literature. Gland Surg 2020; 9 (02) 596-602
  • 28 Guerra AB, Metzinger SE, Bidros RS. et al. Bilateral breast reconstruction with the deep inferior epigastric perforator (DIEP) flap: an experience with 280 flaps. Ann Plast Surg 2004; 52 (03) 246-252
  • 29 Philbert D, Fowler JD, Clapson JB. Free microvascular transplantation of the trapezius musculocutaneous flap in dogs. Vet Surg 1992; 21 (06) 435-440
  • 30 Vaienti L, Gazzola R, Benanti E. et al. Failure by congestion of pedicled and free flaps for reconstruction of lower limbs after trauma: the role of negative-pressure wound therapy. J Orthop Traumatol 2013; 14 (03) 213-217
  • 31 Stehbens WE. Postmastectomy serous drainage and seroma: probable pathogenesis and prevention. ANZ J Surg 2003; 73 (11) 877-880
  • 32 Fay MF. Drainage systems. Their role in wound healing. AORN J 1987; 46 (03) 442-455
  • 33 Jeon BJ, Lee TS, Lim SY. et al. Risk factors for donor-site seroma formation after immediate breast reconstruction with the extended latissimus dorsi flap: a statistical analysis of 120 consecutive cases. Ann Plast Surg 2012; 69 (02) 145-147
  • 34 Song D, Slater K, Papsdorf M. et al. Autologous Breast Reconstruction in Women Older Than 65 Years Versus Women Younger Than 65 Years: A Multi-Center Analysis. Ann Plast Surg 2016; 76 (02) 155-163
  • 35 Pollock TA, Pollock H. Drainless Abdominoplasty Using Progressive Tension Sutures. Clin Plast Surg 2020; 47 (03) 351-363
  • 36 Rodby KA, Stepniak J, Eisenhut N, Lentz III CW. Abdominoplasty with suction undermining and plication of the superficial fascia without drains: a report of 113 consecutive patients. Plast Reconstr Surg 2011; 128 (04) 973-981
  • 37 Pollock TA, Pollock H. Progressive tension sutures in abdominoplasty: a review of 597 consecutive cases. Aesthet Surg J 2012; 32 (06) 729-742
  • 38 Sforza M, Husein R, Andjelkov K, Rozental-Fernandes PC, Zaccheddu R, Jovanovic M. Use of Quilting Sutures During Abdominoplasty to Prevent Seroma Formation: Are They Really Effective?. Aesthet Surg J 2015; 35 (05) 574-580
  • 39 Fang CL, Changchien CH, Chen MS. et al. The Effects of Combining Progressive Tension Sutures, Closed Drain, and Fibrin Sealant in Abdominoplasty Wound After Deep Inferior Epigastric Perforator Flap Harvesting. Ann Plast Surg 2020; 84 (1S): (Suppl. 01) S89-S93
  • 40 Ardehali B, Fiorentino F. A Meta-Analysis of the Effects of Abdominoplasty Modifications on the Incidence of Postoperative Seroma. Aesthet Surg J 2017; 37 (10) 1136-1143
  • 41 Prantl L, Moellhoff N, Fritschen UV. et al. Impact of Smoking Status in Free Deep Inferior Epigastric Artery Perforator Flap Breast Reconstruction: A Multicenter Study. J Reconstr Microsurg 2020; 36 (09) 694-702
  • 42 Daly LT, Doval AF, Lin SJ, Tobias A, Lee BT, Dowlatshahi AS. Role of CTA in Women with Abdominal Scars Undergoing DIEP Breast Reconstruction: Review of 1,187 Flaps. J Reconstr Microsurg 2020; 36 (04) 294-300
  • 43 Parrett BM, Caterson SA, Tobias AM, Lee BT. DIEP flaps in women with abdominal scars: are complication rates affected?. Plast Reconstr Surg 2008; 121 (05) 1527-1531