Shifting Towards Total Drainless Approach in DIEP Flap-Based Breast Reconstruction: Evaluation of Safety

With an increasing interest on swift postoperative recovery, there has been a trend towards omitting drains in deep inferior epigastric perforator (DIEP) flap-based breast reconstruction, aiming to avoid drains in both the breasts and abdomen ideally. This study evaluates our transition towards total drainless reconstruction, focusing specifically on the safety of omitting drains in the breasts.Patients who underwent breast reconstruction with DIEP flap from 2018 to 2023 were reviewed. They were divided into three groups: group A (placing drains in both abdomen and breast), group B (only in breast) and group C (total drainless). For group C, routine ultrasound examinations were performed to check for fluid accumulation. Complication profiles were compared among the groups.In total, 294 cases were included, comprising 77 in group A, 112 in group B, and 105 in group C. Chronologically, a gradual increase in the proportion of group C was observed, with the complication rates remaining stable. In comparison of the complication profiles of the recipient and donor sites among the three groups, no significant differences were found. Breast seroma, persisting after postoperative one month, was exclusively detected in six (5.7%) cases within group C, all of which were treated with outpatient clinic-based aspiration. When restricting the analysis to group C, having a greater weight of mastectomy specimen and conducting axillary lymph node dissections exhibited an independent association with the development of breast seroma.Smooth transition to total drainless DIEP breast reconstruction appears safe, not significantly increasing complication risks.