Predictive factors of drainage volume and drain duration after the inframammary approach to nipple-areolar-complex sparing mastectomy and implant-based breast reconstruction

Background Prepectoral breast reconstruction has recently gained wide recognition for its advantages, such as rapid recovery and less pain. This study compared the effectiveness of and differences between the prepectoral and subpectoral breast reconstruction techniques.Methods Eighty-three patients (90 breasts) who underwent prepectoral or subpectoral breast reconstruction surgery between January 2019 and December 2020 were prospectively recruited. Patient demographics, comorbidities, oncological treatment, and intraoperative and postoperative data were evaluated to investigate the validity and stability of each surgical technique. The follow-up period was a minimum of 18 months.Results The surgical cohorts (22 prepectoral and 68 subpectoral) had comparable demographics. No significant differences in postoperative complications were observed between the two groups. The prepectoral group showed shorter operation times than the subpectoral group (mean: 97.27 and 127.63 minutes, respectively; P<0.001). Fewer days elapsed until drain removal and the total amount of drainage was less in the prepectoral group than in the subpectoral group (mean: postoperative day [POD] 8.95 and 10.06, respectively; P=0.048) and (501.72 mL and 671.19 mL, respectively; P=0.009). The numeric pain rating scale (NPRS) scores at POD 7 were significantly lower in the prepectoral group than in the subpectoral group (mean: 0.41 and 1.82, respectively; P=0.029). There were no statistically significant differences in the NPRS scores at POD 1 or the BREAST-Q questionnaire scores at 3 months.Conclusions Prepectoral breast reconstruction using acellular dermal matrix can feasibly replace the conventional subpectoral breast reconstruction technique and has the advantages of reducing operation time, length of hospitalization, and long-term postoperative pain.

Section: Discussionsupporting

confidence: 87%

A prospective comparison of prepectoral and subpectoral methods for immediate breast reconstruction with acellular dermal matrix: the cogwheel-shaped anterior wrapping method

Kim

Chun

Park

et al. 2022

“…Obesity, implant size, mastectomy volume, and preoperative irradiation are known to increase the risk of seroma formation during prosthetic breast reconstruction [13,14]. All these factors are supported by some clinical evidence, although none are considered conclusive.…”

Section: Discussionmentioning

confidence: 99%

Drainage and seroma formation according to the size of sterile acellular dermal matrix in direct-to-implant breast reconstruction

Kong¹,

Kim²,

Lee³

2022

Background Acellular dermal matrix (ADM) is widely used for prosthetic breast reconstruction. Although many studies have investigated the efficacy and complications of ADM in prosthetic breast reconstruction, studies on drainage and seroma formation according to the size of ADM manufactured using the same process are lacking. This study analyzed drainage and seroma formation according to the size of sterile ADM.Methods From January 2011 to June 2018, the authors retrospectively reviewed the medical charts of patients who underwent direct-to-implant breast reconstruction using MegaDerm at a single institution. The ADMs used were classified as small or large groups. The two groups were compared in terms of the volume and duration time of two closed-suction drains (supramuscular and submuscular drains). Seroma and infection risk were also analyzed.Results Of 344 patients, 69 were included. Among them, 22 patients were in the small-ADM group and 47 patients were in the large-ADM group. The supramuscular drain volume (P=0.295) and time (P=0.365) were not significantly different between the two groups. However, the submuscular (P=0.001) and total drain volume (P=0.004) were higher in the large-ADM group. In addition, seroma occurred significantly more frequently in the large-ADM group (P=0.048), but there was no significant difference in minor infections (P=0.088).Conclusions The size of sterile ADM affected drainage and seroma formation, with a larger size increasing drain volume and seroma risk. This study could provide a clinical basis for the safe usage of large sterile ADM.

“…The occurrence of seroma following prosthetic breast reconstruction can range between 0.2% and 20% [1][2][3][4][5][6]. There is a strong correlation between seroma and the volume of postoperative drainage.…”

Section: Introductionmentioning

confidence: 99%

Does the dominant hand’s use affect the complication rates in prosthetic breast reconstruction?

Jeong,

Hwang,

et al. 2023

Background Numerous studies have investigated risk factors for unfavorable outcomes in prosthetic breast reconstruction, such as obesity, perioperative radiotherapy, and acellular dermal matrix use. However, no reports have explored whether the use of the dominant hand influences complications in breast reconstruction. To address this gap in the literature, analyzed complication rates between the dominant and non-dominant sides after reconstruction.Methods We retrospectively reviewed the charts of 160 patients (170 breasts) who underwent breast reconstruction from February 2017 to March 2022. We analyzed the complications between beasts on the dominant and non-dominant sides according to the reconstruction method.Results During prosthetic breast reconstruction, the drainage volume and duration on the dominant side exceeded those on the non-dominant side after reconstruction (duration: 9.79 days on the dominant side vs. 9.12 days on the non-dominant side, P=0.196; volume: 771.1 mL on the dominant side vs. 654.3 mL on the non-dominant side, P=0.027). The incidence of complications such as wound dehiscence, mastectomy flap necrosis, and infection was significantly higher in the dominant hand group (infection: 6 vs. 0, P=0.014; dehiscence: 15 vs. 4, P=0.009; flap necrosis: 13 vs. 4, P=0.024).Conclusions Complications including seroma, infection, and mastectomy skin flap necrosis following prosthetic reconstruction were common in breasts on the dominant-hand side. Therefore, meticulous management and restriction of shoulder movement can aid in preventing seroma-related complications in prosthetic breast reconstruction, especially on the side of the dominant hand.