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

  • Lim, Yoon Min (Department of Plastic and Reconstructive Surgery, Institute for Human Tissue Restoration, Yonsei University College of Medicine) ;
  • Lew, Dae Hyun (Department of Plastic and Reconstructive Surgery, Institute for Human Tissue Restoration, Yonsei University College of Medicine) ;
  • Roh, Tai Suk (Department of Plastic and Reconstructive Surgery, Institute for Human Tissue Restoration, Yonsei University College of Medicine) ;
  • Song, Seung Yong (Department of Plastic and Reconstructive Surgery, Institute for Human Tissue Restoration, Yonsei University College of Medicine)
  • Received : 2019.03.07
  • Accepted : 2019.11.15
  • Published : 2020.01.15

Abstract

Background Closed-suction drains are widely used in expander-based breast reconstruction. These drains are typically removed using a volume-based criterion. The drainage volume affects the hospital stay length and the recovery time. However, few studies have analyzed the factors that influence drainage volume after expander-based breast reconstruction. Methods We retrospectively analyzed data regarding daily drainage from patients who underwent expander-based breast reconstruction between April 2014 and January 2018 (159 patients, 176 expanders). Patient and operative factors were analyzed regarding their influence on total drainage volume and drain placement duration using univariate and multivariate analyses and analysis of variance. Results The mean total drainage volume was 1,210.77±611.44 mL. Univariate analysis showed correlations between total drainage volume and age (B=19.825, P<0.001), body weight (B=17.758, P<0.001), body mass index (B=51.817, P<0.001), and specimen weight (B=1.590, P<0.001). Diabetes history (P<0.001), expander type (P<0.001), and the surgical instrument used (P<0.001) also strongly influenced total drainage. The acellular dermal matrix type used did not affect total drainage (P=0.626). In the multivariate analysis, age (B=11.907, P=0.004), specimen weight (B=0.927, P<0.001), and expander type (B=593.728, P<0.001) were significant predictors of total drainage. Conclusions Our findings suggest that the total drainage and the duration of drain placement needed after expander-based breast reconstruction can be predicted using preoperative and intraoperative data. Patient age, specimen weight, and expander type are important predictors of drainage volume. Older patients, heavier specimens, and use of the Mentor rather than the Allergan expander corresponded to a greater total drainage volume and a longer duration of drain placement.

Keywords

References

  1. Phillips BT, Wang ED, Mirrer J, et al. Current practice among plastic surgeons of antibiotic prophylaxis and closed-suction drains in breast reconstruction: experience, evidence, and implications for postoperative care. Ann Plast Surg 2011;66:460-5. https://doi.org/10.1097/SAP.0b013e31820c0593
  2. Khansa I, Hendrick RG Jr, Shore A, et al. Breast reconstruction with tissue expanders: implementation of a standardized best-practices protocol to reduce infection rates. Plast Reconstr Surg 2014;134:11-8.
  3. Xue DQ, Qian C, Yang L, et al. Risk factors for surgical site infections after breast surgery: a systematic review and meta-analysis. Eur J Surg Oncol 2012;38:375-81. https://doi.org/10.1016/j.ejso.2012.02.179
  4. Murray JD, Elwood ET, Jones GE, et al. Decreasing expander breast infection: a new drain care protocol. Can J Plast Surg 2009;17:17-21.
  5. Patel VP, Walsh M, Sehgal B, et al. Factors associated with prolonged wound drainage after primary total hip and knee arthroplasty. J Bone Joint Surg Am 2007;89:33-8. https://doi.org/10.2106/00004623-200701000-00005
  6. Suga H, Shiraishi T, Shibasaki Y, et al. Predictive factors for drainage volume after expander-based breast reconstruction. Plast Reconstr Surg Glob Open 2016;4:e727. https://doi.org/10.1097/GOX.0000000000000752
  7. Woo KJ, Paik JM, Mun GH, et al. Analysis of factors influencing drain amount, time to drain removal, and seroma formation in patients undergoing immediate expander-implant breast reconstruction. J Plast Surg Hand Surg 2018;52:53-9. https://doi.org/10.1080/2000656X.2017.1330208
  8. Somers RG, Jablon LK, Kaplan MJ, et al. The use of closed suction drainage after lumpectomy and axillary node dissection for breast cancer: a prospective randomized trial. Ann Surg 1992;215:146-9. https://doi.org/10.1097/00000658-199202000-00009
  9. Unalp HR, Onal MA. Analysis of risk factors affecting the development of seromas following breast cancer surgeries: seromas following breast cancer surgeries. Breast J 2007;13: 588-92. https://doi.org/10.1111/j.1524-4741.2007.00509.x
  10. 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;69:145-7. https://doi.org/10.1097/SAP.0b013e3182259337
  11. 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;76:155-63. https://doi.org/10.1097/SAP.0000000000000527
  12. Butz DR, Lapin B, Yao K, et al. Advanced age is a predictor of 30-day complications after autologous but not implant-based postmastectomy breast reconstruction. Plast Reconstr Surg 2015;135:253e-261e. https://doi.org/10.1097/PRS.0000000000000988
  13. Woerdeman LA, Hage JJ, Hofland MM, et al. A prospective assessment of surgical risk factors in 400 cases of skin-sparing mastectomy and immediate breast reconstruction with implants to establish selection criteria. Plast Reconstr Surg 2007;119:455-63. https://doi.org/10.1097/01.prs.0000246379.99318.74
  14. Duggal CS, Grudziak J, Metcalfe DB, et al. The effects of breast size in unilateral postmastectomy breast reconstruction. Ann Plast Surg 2013;70:506-12. https://doi.org/10.1097/SAP.0b013e318263f1f8
  15. Wang F, Alvarado M, Ewing C, et al. The impact of breast mass on outcomes of total skin-sparing mastectomy and immediate tissue expander-based breast reconstruction. Plast Reconstr Surg 2015;135:672-9. https://doi.org/10.1097/PRS.0000000000000953
  16. Francis SH, Ruberg RL, Stevenson KB, et al. Independent risk factors for infection in tissue expander breast reconstruction. Plast Reconstr Surg 2009;124:1790-6. https://doi.org/10.1097/PRS.0b013e3181bf80aa
  17. Atlan M, Nuti G, Wang H, et al. Breast implant surface texture impacts host tissue response. J Mech Behav Biomed Mater 2018;88:377-85. https://doi.org/10.1016/j.jmbbm.2018.08.035
  18. U.S. Food & Drug administration. Medical device reports of breast implant-associated anaplastic large cell lymphoma [Internet]. Silver Spring, MD: Food and Drug Administration [cited 2019 Jul 4]. Available from: https://www.fda.gov/medical-devices/breast-implants/medical-device-reports-breast-implant-associated-anaplastic-large-cell-lymphoma.
  19. Australian Therapeutic Goods Administration. Breast implants: update on TGA monitoring of anaplastic large cell lymphoma [Internet]. Symonston ACT, Australian Therapeutic Goods Administration [cited 2019 Oct 17]. Available from https://www.tga.gov.au/alert/breast-implants-and-anaplastic-large-cell-lymphoma.
  20. Song J, Zhang X, Liu Q, et al. Impact of neoadjuvant chemotherapy on immediate breast reconstruction: a meta-analysis. PLoS One 2014;9:e98225. https://doi.org/10.1371/journal.pone.0098225
  21. Gfrerer L, Mattos D, Mastroianni M, et al. Assessment of patient factors, surgeons, and surgeon teams in immediate implant-based breast reconstruction outcomes. Plast Reconstr Surg 2015;135:245e-252e. https://doi.org/10.1097/PRS.0000000000000912
  22. Andeweg CS, Schriek MJ, Heisterkamp J, et al. Seroma formation in two cohorts after axillary lymph node dissection in breast cancer surgery: does timing of drain removal matter? Breast J 2011;17:359-64. https://doi.org/10.1111/j.1524-4741.2011.01099.x
  23. Wang F, Peled AW, Chin R, et al. The impact of radiation therapy, lymph node dissection, and hormonal therapy on outcomes of tissue expander-implant exchange in prosthetic breast reconstruction. Plast Reconstr Surg 2016;137:1-9. https://doi.org/10.1097/PRS.0000000000001866

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