The nearly 2,500-patient study found no benefit from drain use, including among patients considered at higher risk for complications.

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Interview by Alyx Arnett

Breast reduction has traditionally involved the use of surgical drains to help prevent postoperative complications, but evidence supporting the practice has been mixed. 

Previous studies have found similar complication rates with and without drains, although many have been too small to determine whether certain patients—particularly those at higher risk for complications—might benefit from their use, says Yemi Ogunleye, MD, SM, FACS, associate professor of plastic surgery at the University of North Carolina.

To take a closer look, Ogunleye and colleagues analyzed 2,488 breast reduction procedures across five academic institutions, comparing postoperative outcomes in patients who received drains with those who did not. 

In this Research Q&A, Ogunleye discusses what the study found, which factors were associated with complications, whether routine drain use should be reconsidered, and how the findings have changed his own surgical practice.

[Editor’s note: Read the full study, “Drain use and complications after breast reduction in a 5–academic institution cohort,” in Plastic and Reconstructive Surgery.]

PSP: What were the key findings?

Our study, the largest ever published of primary data from five institutions, found that while intraoperative drain use did not have an impact (positive or negative) on complications, patients with high BMI and hypertension were more likely to have complications. 

An additional analysis to check if there was a benefit to using drains in patients with larger breasts (and more breast tissue removed) or those with morbid obesity also did not show any impact on reducing complications.

PSP: Were there any results that surprised you?

We were surprised that there was no benefit to drain use in any of the high-risk groups studied, especially as most surgeons theorize a need for drains when a lot of tissue is removed and more dead space is created. Patients with more than 1.5 kg of breast tissue removed per side were a group that should have shown some benefit if there was any real benefit of drains.

PSP: Did your study identify any patient characteristics or risk factors associated with postoperative complications?

Yes, we found high BMI (obesity) and hypertension increased the risk of complications—3% increased odds for each one unit BMI increase, and 36% increased odds in hypertensives compared to non-hypertensives.

PSP: Based on your findings, should surgeons reconsider routine drain use?

Yes, our studies show no difference in complication rates whether drains are used or not. Given the discomfort to patients, it’s difficult to justify routine use. We would hope to perform a large clinical trial to identify any other populations or factors that may benefit from drain use but can’t find any based on this data.

PSP: Have these findings changed your own approach to drain use in breast reduction surgery?

Yes, these findings have informed my cessation of drain use in breast reductions altogether. In the past, I had used it in select groups I considered likely to benefit, which was not shown in the study.

PSP: How do your findings fit within the broader body of evidence on drain use in reduction mammaplasty?

Our study joins the majority of published literature which shows little to no benefit for drain use in breast reductions. Having such a large group of patients allows us to perform the subgroup analyses within those high-risk groups and show there was no benefit in our population.

PSP: What additional research is needed to better define best practices for drain use after breast reduction surgery?

More adequately powered randomized clinical trials are needed in this space to study the research question further in breast reductions. Such studies can also assess sensation, postoperative esthetic results, and further characterize the subgroups of patients that have worse (or better) outcomes with drain use.

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