There’s no sugarcoating it: surgical drains are a necessary evil. In fact, Dr. Nelson Castillo, a board-certified plastic surgeon in Atlanta, admits, “They’re probably one of the most annoying things for patients in recovery.” But if you’re considering any number of the most popular cosmetic procedures, you’re likely looking at a post-op period spent dealing with a drain or two. It’s a detail that can freak a lot of patients out (and one that doctors might mention as an afterthought because it’s so commonplace), but knowing what to expect ahead of time will make the recovery process that much more manageable.
What is a surgical drain?
A drain is a soft silicone tube implanted in the body and attached to a suction device that draws out excess fluids. “The one-way valve slowly inflates with air—and as it inflates, it creates a vacuum that pulls out accumulated fluid from the surgical space,” explains Dr. Castillo. “A lot of people think drains are there to prevent blood clots from forming, but a clot would just clog the drain. They’re for more normal fluids.”
The most common type is a Jackson-Pratt drain (named for the two neuroscientists who invented it), though they range in shape and size. “Some are round, some are flat and rectangular in shape, with a tapered end to prevent them from getting pulled out very easily, and some are fluted, meaning they have little holes punctured into them for the fluid to escape through,” says Dr. Castillo.
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What exactly is the fluid that’s coming out?
Dr. Elizabeth Lee, a board-certified plastic surgeon in Lafayette, California, describes it as a “serum similar to what’s inside a blister.” Basically, it’s some combination of plasma, blood, lymph, and pus. “In general, the serum will look a little bit bloody when it first starts. As it gets thinner, it’ll turn a Hawaiian Punch color, then it goes to a straw color by the end,” she says.
What procedures typically require surgical drains?
Tummy tucks, facelifts, neck lifts, arm lifts, and breast lifts and reductions generally involve at least one drain. “There’s a lot of debate back and forth on whether they’re actually needed or if you can take other precautionary steps to limit the use of them. Some people use none, but almost any procedure can justify the use of a drain to wick away fluid,” says Dr. Castillo.
Dr. Lee calls drainless approaches “a gimmicky way to attract patients” and says that the steps doctors have to take to make a surgery like abdominoplasty drainless carry more risk. “I always tell my patients that drains are a possibility, because I can’t predict whether I’m going to get in there and find them oozing blood more than I would like and I don’t feel comfortable closing them up without something to pull any drainage out.”
What do they feel like?
It depends on the type of drain used, but for the most part, you shouldn’t feel it—and if you do, it’s just a mildly strange sensation. But if you have one that’s a bit larger in caliber, says Dr. Castillo, you may feel irritation or pain when you twist or turn, because the end can poke into the skin. You’ll likely feel the drain most when it’s being removed. “Patients never say it hurts—they just say, ‘Oh man, that felt really weird.’ Everyone uses the word ‘weird,’” says Dr. Castillo.
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How easy is it to accidentally rip a drain out?
Not easy. Most doctors will put in a single stitch to hold the drain in place, and you’re usually required to wear a compression garment over it. “In 24 years of being in practice, I’ve only had one patient who inadvertently pulled the drain out,” says Dr. Lee.
What do you have to avoid with drains?
Your doctor will give you a list of activities to avoid during recovery, and for the most part, they’ll apply whether you have surgical drains or not. Exercise, heavy lifting, sharp twisting and turning, and reaching above your shoulders are no-brainers, but you’ll want to ask your doctor for specifics when it comes to bathing. Dr. Lee advises her patients to stay completely dry until the drains are out; Dr. Castillo allows patients to shower, so long as they don’t submerge the hole.
How long do surgical drains stay in?
In most cases, drains are out within a week, but it’s dependent on the procedure. A tummy tuck can require up to two weeks, whereas drains in the face or neck are usually out in two to three days, according to Dr. Castillo. “Patients should empty their drains, and measure how much was drained, three times a day. Basically, the drains will be ready to come out when they are letting out less than 30 ml a day,” offers Dr. John Paul Tutela, a board-certified plastic surgeon in Livingston, New Jersey.
