Drain Removal on Postoperative Safety and Patient Satisfaction in R-E-NSM With Prepectoral DIBR

NCT ID: NCT07237828

Last Updated: 2025-11-20

Basic Information

• Recruitment Status: NOT_YET_RECRUITING
• Clinical Phase: NA
• Total Enrollment: 379 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2025-12-01
• Study Completion Date: 2032-06-30

Brief Summary

Breast cancer is a malignant tumor that seriously threatens the health of women, with an increasing incidence rate. The current main treatment methods include multidisciplinary diagnosis and treatment such as surgery, radiotherapy, chemotherapy, and endocrine therapy, among which surgery is the key. Postoperative care is also very important. Traditional breast surgery requires long-term placement of drainage tubes after the operation. However, long-term placement of drainage tubes increases the incidence of postoperative complications such as infection and delayed wound healing, prolongs hospital stays, increases economic burden, and also affects the aesthetic outcome. Our team has innovatively adopted the "reverse-sequence" endoscopic nipple-sparing-mastectomy with direct-to-implant breast reconstruction. This method is highly efficient and safe, with no incisions on the surface of the breast, reducing the risk of incision dehiscence and the probability of flap ischemia and necrosis. Based on this, our team proposes to appropriately relax the drainage criteria and remove the drainage tube earlier under the premise of ensuring the sterility of the effusion, and preliminary findings show that patients have better postoperative aesthetic outcomes, with a lower incidence of flap infection, ischemia, and necrosis than expected, and the degree of breast deformation caused by radiotherapy is also reduced. However, there is still controversy over the pros and cons of drainage criteria. Some scholars believe that strict drainage criteria can reduce the risk of infection and implant displacement, and plastic surgeons are more concerned about the impact of long-term tube placement on aesthetic outcomes and quality of life. Currently there is a lack of large sample, multicenter, randomized controlled studies to provide high - level evidence. Therefore, our team plans to conduct a national multicenter, open, randomized controlled study to compare the advantages and disadvantages of the two drainage methods under the premise of not reducing postoperative surgical and oncological safety, in order to explore the optimal timing for drain removal and improve patients' satisfaction with the reconstructed breast.

Detailed Description

This study is a multicenter, open, randomized controlled trial. Prior to group allocation, participants were stratified by axillary lymph node dissection. The proportion of patients undergoing axillary lymph node dissection is 25%, while the proportion of patients not undergoing axillary lymph node dissection is 75%. Following stratification, participants within each stratum were randomized in a 3:1 ratio to the intervention or control groups. The target sample size is 379 participants, comprising 95 in the ALND group (71 intervention, 24 control) and 284 in the non-ALND group (213 intervention, 71 control).

An interim analysis will occur 1 year after study initiation and 1 month post-enrollment completion. Final analysis follows 5-year postoperative follow-up for all participants. Categorical variables will be analyzed using chi-square or Fisher's exact tests; continuous variables via t-tests, ANOVA, or non-parametric alternatives (Mann-Whitney/Kruskal-Wallis) as appropriate. Survival outcomes will employ Kaplan-Meier curves with log-rank testing.

Conditions

Breast Cancer

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: TREATMENT
• Blinding Strategy: NONE

Study Groups

Intervention group

Remove drainage tubes on postoperative day 5

Group Type: EXPERIMENTAL

Drain Removal Timing After Endoscopic Breast Reconstruction Surgery

Intervention Type: PROCEDURE

The optimal timing for earlier or later removal of drainage tubes after endoscopic breast reconstruction surgery.

Control group

Remove drainage tubes when the daily drainage volume is less than 30 ml/day for two consecutive days after surgery.

Group Type: NO_INTERVENTION

No interventions assigned to this group

Interventions

Drain Removal Timing After Endoscopic Breast Reconstruction Surgery

The optimal timing for earlier or later removal of drainage tubes after endoscopic breast reconstruction surgery.

Intervention Type: PROCEDURE

Eligibility Criteria

Inclusion Criteria

• Female patients aged 18-70 years (inclusive);
• Patients scheduled for unilateral or bilateral reverse-sequence endoscopic nipple-sparing- mastectomy with immediate prepectoral direct-to-implant breast reconstruction, with the option of concurrent contralateral endoscopic breast augmentation;
• Patients with preoperative pathological confirmation of carcinoma in situ, invasive cancer, or those undergoing prophylactic mastectomy;
• Patients with a maximum tumor diameter≤5 cm (before/after neoadjuvant chemotherapy), and no clinical or radiological evidence of nipple, skin, chest wall invasion, or distant metastasis;
• BMI < 40 kg/m²;
• Implant volume < 600 mL;
• Patients who are able and willing to sign the informed consent form.

Exclusion Criteria

• History of breast surgery within 1 year prior to this operation (excluding VABB and biopsy);
• Tumor invasion of the skin, pectoralis major muscle, chest wall, or nipple-areola complex;
• Advanced tumor stage (M1);
• Breast cancer during pregnancy or lactation;
• Scars below the nipple level and a history of previous radiotherapy;
• Patients with severe comorbidities before surgery, poorly controlled diabetes, immunodeficiency, or poor general condition that cannot tolerate surgery;
• HbA1c > 7.5%;
• Active smoking history (≥20 cigarettes per day);
• Intraoperative flap burns, intraoperative nipple excision; postoperative complications such as infection, flap ischemia, or surgical cavity bleeding within 1-4 days after surgery; or other causes leading to incisions on the surface of the breast; patients who undergo nipple excision within 1 month after surgery should be excluded from the study;
• Currently participating in other clinical studies that may affect participation in this trial.
• Refusal to sign the informed consent form.

• Minimum Eligible Age: 18 Years
• Maximum Eligible Age: 70 Years
• Eligible Sex: FEMALE
• Accepts Healthy Volunteers: No

Sponsors

The First Affiliated Hospital of Shanxi Medical University

OTHER

Sponsor Role: collaborator

West China Fourth Hospital of Sichuan University

UNKNOWN

Sponsor Role: collaborator

Bethune Hospital of Shanxi Medical University

UNKNOWN

Sponsor Role: collaborator

The First Hospital of Jilin University

OTHER

Sponsor Role: collaborator

Shanxi Province Cancer Hospital

OTHER

Sponsor Role: collaborator

Suining Central Hospital

OTHER

Sponsor Role: collaborator

The Second Affiliated Hospital of Kunming Medical University

OTHER

Sponsor Role: collaborator

Zhengzhou Central Hospital

OTHER

Sponsor Role: collaborator

Deyang People's Hospital

OTHER

Sponsor Role: collaborator

Suzhou Municipal Hospital

OTHER

Sponsor Role: collaborator

Chengdu Fifth People's Hospital

OTHER

Sponsor Role: collaborator

Hunan University of Traditional Chinese Medicine

OTHER

Sponsor Role: collaborator

The First Affiliated Hospital of Zhengzhou University

OTHER

Sponsor Role: collaborator

The Fourth People's Hospital of Sichuan Province

UNKNOWN

Sponsor Role: collaborator

China-Japan Union Hospital, Jilin University

OTHER

Sponsor Role: collaborator

Guangzhou First People's Hospital

OTHER

Sponsor Role: collaborator

Xinjiang Medical University Affiliated Cancer Hospital

UNKNOWN

Sponsor Role: collaborator

Fujian Medical University Union Hospital

OTHER

Sponsor Role: collaborator

Central Hospital of Taiyuan

UNKNOWN

Sponsor Role: collaborator

West China Tianfu Hospital of Sichuan University

UNKNOWN

Sponsor Role: collaborator

Du Zhenggui

OTHER

Sponsor Role: lead

Responsible Party

Du Zhenggui

Clinical Professor

Responsibility Role: SPONSOR_INVESTIGATOR

Locations

West China Hospital, SiChuan University

Chengdu, Sichuan, China

Countries

China

Central Contacts

Zhenggui Du, Dr

Role: CONTACT

docduzg@163.com

+86 13880768222

Tianyuan Li

Role: CONTACT

Lity0526@163.com

+86 15510183188

Facility Contacts

Zhenggui Du, Dr

Role: primary

docduzg@163.com

+86 13880768222

Tianyuan Li

Role: backup

Lity0526@163.com

+86 15510183188

References

Feng Y, Xie Y, Liang F, Zhou J, Yang H, Qiu M, Zhang Q, Liu Y, Liang P, Du Z. Twenty-four-hour discharge of patients after endoscopic nipple-sparing mastectomy and direct-to-implant breast reconstruction: safety and aesthetic outcomes from a prospective cohort study. Br J Surg. 2024 Jan 3;111(1):znad356. doi: 10.1093/bjs/znad356. No abstract available.

Reference Type: BACKGROUND

PMID: 37991082 (View on PubMed)

Zhou J, Xie Y, Liang F, Feng Y, Yang H, Qiu M, Zhang Q, Chung K, Dai H, Liu Y, Liang P, Du Z. A novel technique of reverse-sequence endoscopic nipple-sparing mastectomy with direct-to-implant breast reconstruction: medium-term oncological safety outcomes and feasibility of 24-h discharge for breast cancer patients. Int J Surg. 2024 Apr 1;110(4):2243-2252. doi: 10.1097/JS9.0000000000001134.

Reference Type: BACKGROUND

PMID: 38348883 (View on PubMed)

Yang H, Liang F, Xie Y, Qiu M, Du Z. Single axillary incision reverse-order endoscopic nipple/skin-sparing mastectomy followed by subpectoral implant-based breast reconstruction: Technique, clinical outcomes, and aesthetic results from 88 preliminary procedures. Surgery. 2023 Sep;174(3):464-472. doi: 10.1016/j.surg.2023.05.037. Epub 2023 Jul 7.

Reference Type: BACKGROUND

PMID: 37422354 (View on PubMed)

Zhang S, Xie Y, Liang F, Wang Y, Wen N, Zhou J, Feng Y, Liu X, Lv Q, Du Z. Video-assisted Transaxillary Nipple-sparing Mastectomy and Immediate Implant-based Breast Reconstruction: A Novel and Promising Method. Aesthetic Plast Surg. 2022 Feb;46(1):91-98. doi: 10.1007/s00266-021-02527-6. Epub 2021 Aug 23.

Reference Type: BACKGROUND

PMID: 34424367 (View on PubMed)

Jia-Jian C, Nai-Si H, Jing-Yan X, Ben-Long Y, Guang-Yu L, Gen-Hong D, Zhi-Min S, Jiong W. Current Status of Breast Reconstruction in Southern China: A 15 Year, Single Institutional Experience of 20,551 Breast Cancer Patients. Medicine (Baltimore). 2015 Aug;94(34):e1399. doi: 10.1097/MD.0000000000001399.

Reference Type: BACKGROUND

PMID: 26313786 (View on PubMed)

Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, Bray F. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021 May;71(3):209-249. doi: 10.3322/caac.21660. Epub 2021 Feb 4.

Reference Type: BACKGROUND

PMID: 33538338 (View on PubMed)

Other Identifiers

2025(440)

Identifier Type: -

Identifier Source: org_study_id