D35. No Drains, No Problem: A Propensity Score Matched Outcomes Analysis of Dual-port Vs Single-port Tissue Expanders

PURPOSE: Closed suction drains and acellular dermal matrix (ADM) are mainstays of two-stage tissue expander postmastectomy breast reconstruction. With new innovations in tissue expander design and refinement of mastectomy techniques, the use of ADM and drains may be unnecessary for safe reconstruction. This study evaluates our institutional experience using dual-port tissue expanders without drain or ADM placement. METHODS: The authors retrospectively identified patients who underwent immediate breast reconstruction with tissue expanders between 2011 and 2022. Breasts in the drainless and drain cohorts were propensity score matched. Primary outcomes were infection and mastectomy skin flap necrosis rates. Multivariate regression analysis identified risk factors for infection. RESULTS: 218 breasts (124 patients) in the drainless cohort were propensity matched with 218 breasts (136 patients) in the drain cohort. Breasts in the drainless cohort had comparable rates of infection (11.2% vs. 8.0%, OR 0.62, p = 0.07) and skin necrosis (10.4% vs. 7.7%, OR 0.71, p = 0.20) as the drain cohort. On multivariate analysis, higher body mass index was a risk factor for infection (OR 1.09, p = 0.005) while prepectoral tissue expander placement decreased risk of infection (OR 0.09, p = 0.01). Age, smoking status, diabetes, hypertension, neoadjuvant chemotherapy, and postoperative radiation were not significant risk factors (p > 0.05). CONCLUSION: Immediate breast reconstruction with dual-port tissue expanders offers a drainless and meshless alternative to traditional implant-based reconstruction while maintaining similar complication rates. Our results advocate for the use of prepectoral dual-port tissue expanders to enhance patient comfort and decrease drain-associated pain.