The Impact of a Drain Antisepsis Protocol on Infection in Implant-Based Breast Reconstruction: A Propensity Score Matched Analysis

Background: Surgical site infection is one of the most common complications following implant-based breast reconstruction and is associated with significant morbidity and healthcare costs. Surgical drains may serve as a conduit for bacterial contamination; however, the impact of a standardized drain antisepsis protocol on clinical infection rates remains incompletely defined. This study analyzes the association between a drain antisepsis protocol and postoperative infection using a propensity score-matched analysis. Methods: A retrospective review was performed for patients undergoing immediate breast reconstruction with a tissue expander (TE). Patients who followed a standardized drain antisepsis protocol, which included use of a chlorhexidine disc exchanged every 7 days at the drain exit site along with daily drain bulb irrigation with Dakin’s solution, both until drain removal, were compared to controls. Propensity score matching was performed based on comorbidities, surgical details, and oncologic treatment plans. Results: A total of 1,765 TEs (1,193 patients) were included, consisting of 450 in the drain antisepsis group and 1,315 controls. After matching, 822 expanders remained, with 411 per group. The infection rate was lower in the drain antisepsis group compared to controls (11.2% vs 16.3%, p = 0.033). The infection-related TE explantation rate was lower among patients in the drain antisepsis group (5.8% vs 10.2%, p = 0.021). Conclusion: Implementation of a standardized drain antisepsis protocol was associated with reduced surgical site infection and device explantation following immediate breast reconstruction with a TE. This simple, low-cost intervention is a practical strategy to mitigate postoperative microbial colonization and infectious complications.