Reduction of seroma and improvement of quality of life after early drain removal in immediate breast reconstruction with tissue expander. Preliminary report from a randomized controlled study

Seroma is the most common complication of breast reconstruction with tissue expander (incidence 0.2-20%) with increased risk of infection and implant loss by 4-6 fold. About 90% of plastic surgeons routinely placed drains for its prevention. We theorized that early drain removal is a safe procedure that improves postoperative quality of life (QoL), reducing pain, length of hospital stay, and limitations on daily activities. We divided 49 patients operated on between September 2016 and March 2018 (follow-up: 9-26 months) into two groups: Group1 (output-based; drains removed when <30 ml/day); and Group2 (early-removal; at 3-4 days postop.). A study-specific questionnaire about the patient's QoL was conducted 3 weeks after surgery. We performed an intention-to-treat analysis. A comparison was performed using a Fisher test and a Mann-Whitney U test with p= 0.05. We observed lower production of wound fluid (641 +/- 49 ml vs 231 +/- 20 ml; p= 0.004), and a shorter time until wound healing (31.3 +/- 4.2 days vs 22 +/- 3.9 days; p= 0.031) for Group 2. The difference for infection (p=0.36), impaired wound healing (p= 0.22), and the seroma formation period (p=0.11) was not significant. Group 2 experienced less breast pain (8% vs 87.5%; p= 0.001), fewer limitations in daily activities (16% vs 50%; p= 0.002), in mobility (20% vs 83.3%; p=0.001), and in social life (8% vs 91.7%; p < 0.001), and a better quality of sleep than Group 1 (36% vs 75%; p= 0.002). Group 2 did not require home care after hospital discharge (p < 0.001). The limitations of study are: its small sample size, the wound healing assessment, and the use of a non-validated questionnaire. (C) 2021 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.