The drain game: Abdominal drains for transverse rectus abdominis myocutaneous breast reconstruction

Introduction: We recently published data for the duration of donor site drain use in latissimus dorsi and deep inferior epigastric perforator breast reconstruction, due to a reported requirement in the literature; evidence is still required for transverse rectus abdominis myocutaneous (TRAM) reconstruction. Aim: To compare inpatient hospital stay, drainage parameters and donor-site complications associated with closed suction abdominal drain removal by post-operative day (POD) 3 regardless of output (early group), versus after POD 3 where instructions were by drainage volume/24 h ± output consistency (late group), in post-mastectomy TRAM breast reconstruction.Method: A retrospective review of TRAM breast reconstructions, between June 2008–2013, was undertaken with a minimum 1 year follow-up per patient.Results: Of 65 patients who underwent TRAM breast reconstruction, 56 hospital records contained complete documentation. Both the late (n = 35) and early (n = 21) drain removal group were matched for age and number of donor site drains (2 per patient). Mean drain removal day (5.34 ± 0.20 days vs. 2.67 ± 0.14 days; p < 0.0001), total drainage (797.86 ± 77.15 mls vs. 295.71 ± 29.72 mls; p < 0.0001) and hospital inpatient stay (7.46 ± 0.29 days vs. 6.09 ± 0.32 days; p = 0.003) were greater for patients in the late versus early group. There were no differences in total complications (5.71% (2/35) vs. 14.29% (3/21); p = 0.28), including seroma (2.86% (1/35) vs. 4.76% (1/21); p = 0.71) rates between the late and early groups.Discussion: These data suggest significant advantages for patients who have abdominal drains removed early by POD 3, without increased post-operative complications including seroma rates; these data are in keeping with our LD data. We recommend drain removal by POD 3.