Should drains be used in breast augmentation?


Drains are used to remove blood (or later, serum), and in some areas, such as tummy tucks, where there is a large potential space for blood or fluid to collect, drains can promote tissue adherence and healing. This is one potential reason to use breast drains--textured implants that must adhere to tissue to prevent inadvertent rotation or malposition. But even here that may not be optimal--acceptable, but not optimal!

The problem is that drains allow fluid or blood OUT of a surgical field, but they are also portals for bacteria INTO a surgical field. In the case of breast augmentation, this field involves implants that can become contaminated with even "non-pathogenic" skin or breast ductal bacteria. This bacterial exposure has been proven to increase the risk of capsular contracture. Drains and tummy tucks where there are no implants--no problem!

But drains into pockets containing implants that cannot fight off infection or even contamination (no blood flow, no antibodies) is an inappropriate risk, IMHO.

Why do you think a surgeon uses drains in breasts? Perhaps s/he is a sloppy or rough surgeon with poor hemostasis (control of bleeding vessels)? Perhaps blunt dissection is used to rip the muscle fibers off the chest wall rather than careful dissection and precise control of bleeding capillaries? Bad surgery? No, but perhaps less than precise and careful technique--it's all in how you do it!

Surgeons who use drains may be stopping the operation before all bleeding is controlled (not just adequately, but completely), and a drain is their "safety net." These surgeons may also use Ace elastic bandages to compress the breasts and any bleeding vessels, or a tight surgical bra.

Perhaps a more careful operation and better control of bleeding is preferable to a drain, tight bra, or Ace bandage.

Choose a surgeon who avoids contamination of your implants by using NO drain, Keller funnel insertion sleeve, Betadine irrigation, no-touch technique, and careful surgery, gentle tissue handling, and precise hemostasis. AVOID the surgeon who uses drains without careful explanation (I don't use drains even when I do extensive capsulectomies or redo breast surgeries--I just keep going until things are dry and no drain is needed.) Dr. Tholen
Article by
Minneapolis Plastic Surgeon