Postoperative Drain Care and Showering following Immediate Breast Reconstruction: A Survey of Common Practices Among 650 ASPS Members.
Brett T. Phillips, MD, Eric D. Wang, BS, Steven T. Lanier, BA BS, Alexander B. Dagum, MD, Sami U. Khan, MD, Duc T. Bui, MD.
Stony Brook University Medical Center, Stony Brook, NY, USA.
Plastic surgeons commonly restrict showering in immediate breast reconstruction (IBR) patients with indwelling closed suction drains (CSDs), although the literature does not provide evidence to recommend this practice. Management may be further complicated by the incompletely studied infectious risks of Acellular Dermal Matrix (ADM). Our study surveys current postoperative showering and drain care practices among plastic surgeons following immediate breast reconstruction.
4669 ASPS and CSPS members were sent an online or paper survey inquiring about CSD management protocols for IBR using tissue expanders (TE) or autologous flaps (AF). Statistical significance of response trends was determined using Fisher’s Exact test.
We received 650 completed surveys, representing a 14% response rate. We attribute this response to an inability to specifically target members who primarily perform breast reconstruction.
Overall, 46%, 42%, and 40% of surgeons restrict showering following TE without ADM, TE with ADM, and AF procedures, respectively. 12% of surgeons who allow showering following AF procedures restrict showering following TE procedures, likely reflecting the perceived risks of an infected expander.
When using ADM in IBR, 76.9% of surgeons do not modify drainage protocols, while 92.6% do not modify antibiotic protocols. Canadians surgeons were much less likely to use ADM (18.6% vs 78.3%, p<0.001) than US surgeons.
Interestingly, trends in drainage protocol were associated with both duration of practice, case volume, and demographics. Surgeons in practice less than 20 years were significantly less likely to restrict showering (TE: 40.3%, AF: 33.1%) than surgeons in practice more than 20 years (TE: 57.1%, AF: 56.0%, p<0.001). Surgeons performing more than 4 TE reconstructions/month were also less likely to restrict showering compared to 1 TE reconstruction/month (39.5% vs 52.4%, p=0.05). Likewise, surgeons performing more than 2 AF reconstructions/month were significantly less likely to restrict showering (26.8% vs. 46.4%, p<0.0001). Canadian surgeons were significantly more likely than US surgeons to restrict showering (TE: 71.2% vs 42.0%; AF: 59.3% vs 37.3%, both p<0.001).
There is no consensus regarding postoperative drain protocols following TE/I reconstruction with or without ADM or autologous reconstruction. As showering restriction can cause significant discomfort for patients, a prospective, randomized study is needed to determine whether an association exists between post-operative showering with CSD and infectious risk.
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