Superomedial pedicle reduction mammaplasty with and without drains: a comparative analysis

Main Article Content

Derek G Liang
Varun Harish
Steven L Merten

Keywords

Mammaplasty, Postoperative complications, Drainage, Hematoma, Seroma

Abstract

Background: Postoperative suction drainage following reduction mammaplasty are purported to reduce complications such as haematoma, seroma, delayed wound healing and loss of nipple or areola. The aim of this study is to compare the complication profile of breast reduction surgery patients who received postoperative drains and those who did not.


Methods: A retrospective analysis of 172 patients over the period January 2011 to June 2017 were identified. Statistical analysis with regression modelling was used to compare the complication profile between patients who had and had not received postoperative drainage.


Results: Patients were divided between ‘drained’ (n=86) and ‘drainless’ (n=86) cohorts with no significant difference in age, smoking and diabetic status between the two groups (p>0.05). Mean body mass index (BMI) was significantly higher in the drained group (29.0) compared to 25.7 in the drainless cohort (p<0.05). Patients in the drained group also had a significantly higher breast weight reduction (660g compared to 536g, p<0.05). There was significantly more vertical skin resection patterns in the drained group (n=25 or 29.1%) compared to the drainless group (n=8 or 9.3%) (with p=0.001). Using multivariate logistic regression, drains resulted in a slightly lower risk for complications but this difference was not statistically significant (OR 0.84; 95% CI=0.39-1.81; p=0.66). However, BMI was strongly associated with complications (p=0.007).


Conclusions: Our results support the contention that routine postoperative drain insertion in reduction mammaplasty does not significantly reduce complications irrespective of the patient’s BMI, breast tissue reduction weight, use of liposuction or skin resection pattern.

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References

1. Collis N, McGuiness CM, Batchelor AG. Drainage in breast reduction surgery: a prospective randomised intra-patient trial. Br J Plast Surg. 2005;58(3):286-89. https://doi.org/10.1016/j.bjps.2004.11.018 PMid:15780221
2. Corion LU, Smeulders MJ, van Zuijlen PP, van der Horst CM. Draining after breast reduction: a randomised controlled inter-patient study. J Plast Reconstr Aesthet Surg. 2009;62(7):865-68. https://doi.org/10.1016/j.bjps.2008.01.009 PMid:18562265
3. Wrye SW, Banducci DR, Mackay D, Graham WP, Hall WW. Routine drainage is not required in reduction mammaplasty. Plast Reconstr Surg. 2003;111(1):113-17. https://doi.org/10.1097/00006534-200301000-00019 PMid:12496571
4. Kosins AM, Scholz T, Cetinkaya M, Evans GR. Evidence-based value of subcutaneous surgical wound drainage: the largest systematic review and meta-analysis. Plast Reconstr Surg. 2013;132(2):443-50. https://doi.org/10.1097/PRS.0b013e3182958945 PMid:23584625
5. Khan SM, Smeulders MJ, Van der Horst CM. Wound drainage after plastic and reconstructive surgery of the breast. Cochrane Database Syst Rev. 2015(10):CD007258. https://doi.org/10.1002/14651858.CD007258.pub3
6. Iwuagwu OC, Platt AJ, Drew PJ. Breast reduction surgery in the UK and Ireland: current trends. Ann R Coll Surg Engl. 2006;88(6):585-88. https://doi.org/10.1308/003588406X130598 PMid:17059724 PMCid:PMC1963764
7. Kerrigan CL, Slezak SS. Evidence-based medicine: reduction mammaplasty. Plast Reconstr Surg. 2013;132(6):1670-683. https://doi.org/10.1097/PRS.0b013e3182a807ec PMid:24281593
8. Sugrue CM, McInerney N, Joyce CW, Jones D, Hussey AJ, Kelly JL, Kerin MJ, Regan PJ. Current practice patterns of drain usage amongst UK and Irish surgeons performing bilateral breast reductions: evidence down the drain. J Plast Surg Hand Surg. 2015;49(6):363-66. https://doi.org/10.3109/2000656X.2015.1062386 PMid:26397754
9. Davison SP, Mesbahi AN, Ducic I, Sarcia M, Dayan J, Spear SL. The versatility of the superomedial pedicle with various skin reduction patterns. Plast Reconstr Surg. 2007;120(6):1466-476. https://doi.org/10.1097/01.prs.0000282033.58509.76 PMid:18040175
10. Anzarut A, Edwards DC, Calder K, Guenther CR, Tsuyuki R. Superior pedicle breast reduction techniques increase the risk of postoperative drainage. Ann Plast Surg. 2008;60(4):367-71. https://doi.org/10.1097/SAP.0b013e31812f7ba7 PMid:18362561
11. Matarasso A, Wallach SG, Rankin M. Re-evaluating the need for routine drainage in reduction mammaplasty. Plast Reconstr Surg. 1998;102(6):1917-921. https://doi.org/10.1097/00006534-199811000-00016 PMid:9810986
12. Arrowsmith J, Eltigani E, Krarup K, Varma S. An audit of breast reduction without drains. Br J Plast Surg. 1999;52(7):586-88. https://doi.org/10.1054/bjps.1999.3155 PMid:10658115
13. Vandeweyer E. Breast reduction mammaplasty: shall we drain? Acta Chir Belg. 2003;103(6):596-98. https://doi.org/10.1080/00015458.2003.11679499 PMid:14743566
14. Dabbah A, Lehman JA, Jr., Parker MG, Tantri D, Wagner DS. Reduction mammaplasty: an outcome analysis. Ann Plast Surg. 1995;35(4):337-41. https://doi.org/10.1097/00000637-199510000-00001 PMid:8585673
15. Cunningham BL, Gear AJ, Kerrigan CL, Collins ED. Analysis of breast reduction complications derived from the BRAVO study. Plast Reconstr Surg. 2005;115(6):1597-604 (and erratum 2005;116(1):361).
16. O’Grady KF, Thoma A, Dal Cin A. A comparison of complication rates in large and small inferior pedicle reduction mammaplasty. Plast Reconstr Surg. 2005;115(3):736-42. https://doi.org/10.1097/01.PRS.0000152428.43300.19
17. Scott GR, Carson CL, Borah GL. Maximizing outcomes in breast reduction surgery: a review of 518 consecutive patients. Plast Reconstr Surg. 2005;116(6):1633-639; discussion 40-1. https://doi.org/10.1097/01.prs.0000187145.44732.1b PMid:16267424
18. Chun YS, Schwartz MA, Gu X, Lipsitz SR, Carty MJ. Body mass index as a predictor of postoperative complications in reduction mammaplasty. Plast Reconstr Surg. 2012;129(2):228e-33e. https://doi.org/10.1097/PRS.0b013e31823ae949 PMid:22286438