Toward Drainless Breast Reconstruction: A Pilot Study.

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 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.