Optimal Timing of Drain Removal in Patients with Prolonged High Output Following Tissue Expander Breast Reconstruction

Background: In tissue expander breast reconstruction, surgeons are faced with a dilemma when drain output remains high for a prolonged period of time: removal may predispose to seroma, whereas retention may predispose to infection. The purpose of this study was to determine the optimal timing of drain removal in this patient population. Methods: A retrospective review was conducted of patients who underwent tissue expander breast reconstruction. Groups were compared: control (group 1); prolonged (>1 mo) high drain output (>30 mL/d) with drains removed when output met criteria (<30 mL/d) (group 2); patients with high drain output with drains removed before drains met output criteria and before 1 month postoperatively (group 3); and patients with high drain output with drains removed after 1 month postoperatively (group 4). Results: A total of 175 patients were analyzed. Group 1 (n = 143) and group 2 (n = 6) had similar rates of complications (11.9% versus 16.7%, respectively; P = 0.54). Group 2 had a lower rate of complications than group 3 (n = 18) (16.7% versus 55.6%, respectively; P = 0.16). In group 3, the most common type of complication was infection (60%). Groups 3 and 4 (n = 8) had similar rates of complications (37.5% versus 55.6%, respectively; P = 0.45). Conclusions: Decisions about the optimal timing for drain removal in patients undergoing tissue expander breast reconstruction with prolonged high drain output should be guided by volume of output rather than the duration of time the drain has been in place.