Drain Use and Complications After Breast Reduction in A Five-Academic-Institution Cohort

Background: Over 70,000 reduction mammaplasties were performed in 2022. Previous studies have suggested equivalent overall complication rates with or without intraoperative drains but have been inadequately powered to assess individual outcomes. We aimed to assess whether use of drains was associated with a lower risk of complications after breast reduction in a multi-institutional cohort study. Methods: A retrospective multi-institutional cohort of 2488 breast reduction patients with and without drains was evaluated. Demographic and peri-operative data were compared between groups and the impact of intra-operative drain placement on post-operative outcomes was evaluated. Results: Drains were used in 1163 patients (46.7%) and 1325 (53.3%) were performed without drains. Patients with higher BMI, greater pre-operative breast anthropometrics , greater resection weight, multiple medical comorbidities, superior pedicle and concomitant procedures (p<0.05) were more likely to have drains placed. . Despite these preoperative differences , there was no significant difference in overall complication rate (30.7% vs 27.1%), wound dehiscence (12.3% vs 14.2%), seroma (1.8% vs 2.0%), hematoma (2.9 vs 3.7%), infection (9.7% vs 7.8%) or need for revision surgery (11% vs 10.2%). However elevated BMI was significantly associated with overall complications, seroma and wound dehiscence (all p<0.01) while hematologic disease was also associated with seroma (p<0.01). Summary: Drain placement was not associated with improved outcomes after breast reduction surgery in a large multi-center retrospective cohort. Surgeons were more likely to use drains in patients with higher BMI, larger breasts and higher medical complexity with similar outcomes to the cohort without drains.