Abstract / Summary
Abstract BACKGROUND – The deep inferior epigastric perforator (DIEP) flap is widely used for autologous breast reconstruction. Postoperative fluid-related complications, including seroma, remain a concern. Surgical drains are commonly placed to prevent fluid accumulation. This study evaluates the association between drain use and postoperative complications at both donor and recipient sites. METHODS – A retrospective multicentre cohort study was performed including all patients undergoing DIEP flap breast reconstruction between 2010 and 2024. Primary outcomes were seroma and hematoma formation. Mixed-effects models were used to account for clustering in bilateral procedures. RESULTS – A total of 2,286 flaps in 1,739 patients were analysed. Of these, 1,656 (95.2%) were included in the drain group and 83 (4.8%) in the no-drain group, reflecting a marked cohort imbalance. Recipient-site hematoma rates were higher in the drain group, while seroma rates were comparable. Drain use was not independently associated with recipient-site complications. At both the recipient and donor sites, drain placement was not associated with reduced odds of seroma or hematoma in univariable or multivariable analysis. CONCLUSIONS - Drain placement was not associated with reduced rates of seroma or hematoma at either donor or recipient site. These findings question the routine use of drains in DIEP flap breast reconstruction. Level of Evidence : III (Retrospective comparative study)