Factors contributing to prolonged drain duration in prepectoral staged implant-based breast reconstruction

Background Current literature demonstrates that factors contributing to prolonged drain duration in the subpectoral implant-based and autologous populations include older age, higher body mass index (BMI), history of neoadjuvant chemotherapy, textured tissue expanders, large volumes of initial tissue expander inflation, use of acellular dermal matrix, hypertension, and reoperation. We aim to examine factors contributing to prolonged drain duration in the prepectoral staged implant-based breast reconstruction population. Methods This was a retrospective investigation of 336 patients who underwent prepectoral staged implant-based breast reconstruction between 2018 and 2021 at a single institution. Prolonged drain duration was defined as patients whose drain duration period was at the 75th percentile or above. Patient demographics, comorbidities, medical histories, perioperative variables, and complication rates were recorded. Chi-square and multivariable regression tests were performed to evaluate variables that would impact prolonged drain duration and post-operative complications. Results Of 336 patients (mean age 49.30 ± 10.73), 88 experienced prolonged drain duration (18 days). Higher BMI (obese category) ( p = 0.003) was the only significant predictor of prolonged drain duration. Conclusions In patients undergoing prepectoral staged implant-based reconstruction, BMI above the obese threshold increases the risk of prolonged drain duration. In contrast to prior studies performed in autologous reconstruction and subpectoral reconstruction, other demographic and perioperative factors were not significant predictors of prolonged drain. Given the increasing prevalence and preference for prepectoral breast reconstruction, this study can be used to guide postoperative management concerning drain removal and follow-up parameters. Level of evidence: Level III, Risk/Prognostic