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Incidence Of Complications In Delayed Abdominally-based Flap Breast Reconstruction Utilizing A Drainless Recipient Site: A Case Series
Elizabeth G. Zolper, BS1, Jenna C. Bekeny, BA1, Kenneth L. Fan, MD1, Gabriel Del Corral, MD2.
1MedStar Georgetown University Hospital, Washington, DC, USA, 2MedStar Franklin Square Medical Center, Baltimore, MD, USA.

PURPOSE: Seroma is a common complication after breast surgery such as mastectomy and immediate reconstruction. In the setting of autologous reconstruction, drains are theoretically placed to prevent the pressure of a seroma on the anastomosis. Paradoxically, drains are often placed away from the anastomosis to separate the fresh anastomosis from negative pressure. Furthermore, there is a lack of evidence for the utility of drains in the recipient site in delayed autologous breast reconstruction, particularly when capsulectomies are performed. We reviewed our experience with delayed abdominally-based flap breast reconstruction with a drainless recipient site. METHODS: A single surgeon retrospective case review was performed of delayed abdominally-based flap breast reconstruction utilizing drainless recipient sites from May 2018 to June 2019. Capsulectomies were performed in all patients to allow improved draping of mastectomy flaps and fluid egress. Radiated tissue, particularly in the lower pole, was commonly excised. Primary outcomes were recipient-site complications. RESULTS: Thirty-one delayed abdominally-based flap breast reconstructions that did not utilize drains in the recipient site were identified in 22 patients. Mean age was 53.0 years (SD 9.7). Mean BMI was 31.8 kg/m2 (SD 5.0). Common comorbidities were: obesity 45.4%, prior tobacco use 31.8%, diabetes 10.0%. Median time to abdominally-based flap reconstruction was 27.5 months (IQR 9.9-93.1). There was history of radiation to the breast prior to autologous reconstruction in 17 cases (54.8%). There were 22 muscle sparing transverse rectus abdominis musculocutaneous (msTRAM) flaps and nine deep inferior epigastric artery perforator (DIEP) flaps performed. Ten patients (45.4%) underwent bilateral reconstruction. Mean operative time was 302 minutes (SD 84). Flap take back occurred in one case (3.2%) due to venous congestion. Median length of stay was four days (range 3-5). Recipient-site complications were: healing complications 32.3%, seroma 3.2%, hematoma 3.2%, and fat necrosis 19.4%. Mean follow up was 5.6 months (SD 4.7). CONCLUSIONS: Our data indicates that delayed autologous reconstruction without drain placement at the recipient site can be safe and successful without an increased rate of seroma or anastomotic complications. Adopting a drainless approach may also improve patient satisfaction and decrease discomfort, as well as reduce post-surgical follow up care.


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