A Comparative Study of Drain in Oncoplastic Breast Conserving Surgery (Therapeutic Mammaplasty and Chest Wall Perforator Flap Partial Breast Reconstruction) vs. Mastectomy.

BACKGROUND

Increasingly, breast surgery is same day or 23-hour day-case surgery. Discharge criteria need to ensure patient safety outside hospital. We explore some of the evolving day-case factors in oncoplastic breast surgery (OBS).

MATERIALS AND METHODS

Available data of BMI and drain usage of an OBS practice (Nov 2014-Oct 2019) were reviewed. These were correlated with length of stay (LoS) and complications. Statistical analysis was performed using R programming language; Pearson's correlation, χ test, and Welch's 2 sample t test.

RESULTS

Of 188 patients in the study, drain usage was highest following mastectomy (62%) followed by partial reconstruction and mammaplasty. Drain was associated with increased seroma rates in all three operations. Its use in the partial reconstruction group was associated with significantly longer mean LoS with drain vs. those without drain (0.93 vs. 0.45 day, P = .009). Drain was associated with nonsignificantly longer LoS in both mammaplasty (1.57 vs. 1.00 day, P = .0708) and mastectomy (1.08 vs. 0.927 day, P = .685) groups. The mean BMI across all patients was 27.5, lowest in partial reconstruction (25.31), highest in mammaplasty (31.79), and 27.1 in mastectomy.

CONCLUSION

Drain use did not correlate directly with occurrence of seroma. However, overall, it was associated increased LoS, being significant in the partial reconstruction group. The temporal trend over the dataset shows numerically less drain usage in the latter half of series across all procedures with decreasing LoS. Minimal drain use may allow more day-case OBS.