Toward Drainless Breast Reconstruction: A Pilot Study

Abstract

Background: Implant-based breast reconstruction with immediate tissue expander placement is the predominant form of breast reconstruction in the United States. Closed-suction drains are frequently employed to minimize seroma accumulation, although they carry the risk of serving as a port of entry for bacteria, posing a concern in the presence of implanted materials such as breast implants or acellular dermal matrix. Introduction of a dual-port tissue expander designed to facilitate the collection and removal of seroma fluid provides a new way of performing breast reconstruction without external drains. Methods: We conducted a pilot study using the AlloX2 dual-port expander on five consecutive patients to demonstrate feasibility of this approach at Cedars-Sinai Medical Center by the two senior authors (E.R. and D.K.). Results: Patients averaged seven clinic visits before they were ready for expander exchange, totaling a mean of 137.5 days. Patients averaged 1.9 clinic visits before output was less than 40cm 3 (1.6 for right breasts and 2.2 for left breasts), with two of the patients never reaching that output. There was one complication; a single patient had unilateral flap necrosis and implant exposure due to excessively large breasts and thin skin flaps, necessitating expander removal and latissimus flap reconstruction. The other four patients underwent successful implant reconstruction. Conclusions: This pilot study demonstrates the feasibility of breast reconstruction without external drains using a dual-port expander with built-in seroma reservoir. From these results, it is apparent that dual-port tissue expanders with built-in seroma reservoir offer a safe and effective way to perform breast reconstruction without drains in appropriately selected patients. A larger prospective cohort will be needed to definitively demonstrate lower infection and reconstructive failure rates.

Management of complications following implant-based breast reconstruction: a narrative review

“…Retrospective reviews by Liu et al and Momeni et al report successful treatment of all cases of seroma with in-office aspiration from the integrated drain port ( 49 , 51 ). More recent single center series utilized integrated drain ports for routine aspiration without placing closed-suction drains ( 52 , 53 ). A recent retrospective series by Franck et al noted a similar complication profile and statistically significant decline in postoperative pain scores with drainless dual-port reconstruction compared to use of standard closed-suction drains ( 52 ).…”