Suction Drains for Breast Augmentation Revision
- Asked by imadvice in New York
- 4 years ago
Hi doctors. What are your thoughts of using drains for breast augmentation revisions? My PS is about to perform a capsulorrhaphy on me along with making the pocket larger.
Do you think drains should be used afterwards? What are the pros and cons with suction drains? I am concerned about the increase risk of infection. Will the drains help lessen the formation of scar tissues? Many thanks for your advice in advance.
Drains for revision breast surgery
It is usually safer to use a drain for complex revisional breast surgery when a complete capsulectomy is performed. The large area that must heal may produce fluid inside the breast cavity.
The fluid that collects in the breast after surgery could be difficult to drain with just a needle without endangering the implant.
The infection risk from a drain increases over time, so the drain should typically be removed as soon as the output is low enough that the body can handle the fluid on its own.
You should always feel comfortable contacting your surgeon and asking him about these issues and his or her rationale for using drains. Counseling the patient is part of the surgery process.
Use of drains in breast augmentation revision surgery
The use of drains vary by surgeon, In most instances of mastectomy and reconstruction, drains tend to be unversally utilized. In situtations of infection or bleeding or previous fluid collections such as a seroma where drainage is anticipated, drains will be placed. However, they are not commonly utilized in primary uncomplicated breast augmentation
Web reference: http://www.bodysculptor.com/breast-surgery-chicago/
Base upon findings at the time of surgery and experience of the surgeon
There is no clear answer for the question of when to use a drain. I personally use a drain when needed. If there is excessive bleeding or a difficult dissection then a drain is useful. A drain is not totally without problems and complications can arise from using them. But in many instances they are a necessary evil. Surgical experience is the rule.
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It seems that you don't trust your doctor.
Hi. Based on the various questions you have been asking, I would recommend re-examining your relationship with your surgeon. Don't second guess him. You have to have complete confidence in your surgeon.
Drains are great, by the way.
More pros than cons for a drain in your case
I used to routinely use drains for primary breast augmentations, and pretty much stopped that practice years ago. However, in a revision like you described, I would tend to use a drain, but the final decision would be based on your surgeon's judgement at the time of the surgery. While a drain is a "two way street" I think the chance of an infection from a very temporary drain is remote. Good luck.
When in doubt, drain.
Although many surgeons, including myself, do not drain the breast after routine breast augmentation, revisions may incur more bleeding especially if capsulectomies are performed. However, capsulorrhaphies by themsleves may not require capsulectomies and may not produce much blood loss. Your surgeon will determine the advantages and disadvantages of drains. Risk of injection with the use of drains is very rare and usually occur the longer you leave them in. If you leave them in a long time, then you will presumably have demonstrated a need for them either because of bleeding at surgery or prolonged drainage post-op. If you have little bleeding and little drainage, then the drains should be able to come out quite soon, 1-2 days, and the risk of infection is virtually nil.Bleeding or serous fluid collection around an implant may lead to a high risk of capsular contracture so if there is any doubt, a drain is better than none.
You need drains
Having done an extensive amount of revisionary breast surgery, I can tell you that capsulectomy patients DRAIN serous fluid and need drains for at least a week until the volume is less than 25 cc per day. You do not want a seroma around your new impants as these are difficult to drain without potential harm to the implant and if left undrained, they can increase your recurrent capsular contracture rates. I never use them in primary augmentations but almost always do in secondary cases and am always glad I did. It s amazing how much some people drain.
Web reference: http://www.randcosmeticsurgery.com
Yes for breast augmentation revisions
We do not routinely use drains in our primary breast augmentations. However, for breast revisions we tell our patients that there is at least a 50% chance they will need a suction drain. Many revisions are done for capsular contracture. Although the causes of capsular contracture are not known, some people believe that hematomas or significant blood in the pocket can contribute to a contracture.
Because of that, we prefer to make sure that there is as little blood as possible left in the pocket of a revision. Thus, the recommendation for a drain. The theoretical small chance that an infection could come in through the drain site or by leaving the drain in is usually balanced by the benefit of removing the blood or serous fluid from the pocket.
Most drains can be removed within 48 hours so it is a short time of inconvenience. We usually keep patients on antibiotics until the drains come out. Good luck with your surgery.
Drain Usage For Breast Implants
Thanks for the great question -
You're going to get some variability on answers on this one.
There are pros and cons to drain usage. The pros are they are an effective way to remove accumulating fluid at operative sites. The cons are they create extra scar, they can be a conduit for bacteria which can lead to infection and can be uncomfortable.
In our San Francisco area practice we do not use drains for primary breast augmentation as I feel the fluid accumulation is small and self limiting and the risk of infection to the implants does not warrant it. For patients receiving explant and capsulectomy I very commonly use drains because removing the capsule can cause significant fluid collections into the potential space occupied by the implants.
In your case - it would depend. If there were significant amount of scar tissue that would possibly create a lot of fluid I would consider drains left in place for a short time but I would absolutely individualize it for each patient. There has to be an analysis of the risks and benefits for each patient.
I hope this helps.
Drains and implants
Drains are sometimes used on primary (the first) breast augmentation procedure by different doctors. Sometimes I will use them on patients that I have to remove a capsule. These are often more involved procedures and can induce more bleeding and fluid collection.
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.