Do the use of drains help with capsular contracture?

Question

I am looking to get a BA and had some questions that are outstanding or that I am getting mixed answers on. If someone could be so kind as to help me with these questions I would be very grateful. Thank you.

Vaishali B. Doolabh, MD, FACS · Answer

Hi Lizzylabs.  Drains generally are only necessary if the collection of fluid (serum or blood) is expected or a space needs to be collapsed together with suction, etc.  Neither is generally a problem with routine augmentation.  You are correct that the persistence of excessive blood around an implant may generate inflammation, but this won't necessarily translate into contracture as it takes several weeks for a capsule to form.  Having a drain exiting the skin is always a potential source of introducing bacteria into the breast and its other risks of use have to be weighed against the benefits by your PS. There are many more associations with contracture, such as smoking, autoimmune disorders, poor blood supply, prior contracture, etc. that you should discuss with your PS as well.  Best wishes,

Frank J. Ferraro, MD · Answer

Capsular contracture can be a difficult problem to fix partly because the reason it forms is not entirely clear. I have fixed many and prefer a smooth wall subpectoral. I rarely use drains

Jason Pozner, MD · Answer

I dont know of any studies that show that drain use in primary breast augmentation reduces the incidence of capsular contracture. Breast augmentation should be a very clean and dry procedure so use if drains is really not warranted.In patients with capsular contracture i routinely use drains after capsulectomy. These cases generally cause fluid leakage (not blood) and the drains aid in removal of this fluid.

Richard Pecunia, MD, FACS · Answer

There is no evidence that drains cause or prevent the formation of capsular contracture. There are many other factors that are felt to contribute to the formation of capsular contracture but drains do not affect this. I have used drains on only one patient in 22 years of practice. Hope that helps.

Tom J. Pousti, MD · Answer

Thank you for the question. No, there is no evidence that the use of drains during breast augmentation surgery will help  decrease the incidence of contracture.     Best wishes.

Brooke R. Seckel, MD, FACS (retired) · Answer

Thank you for your important question.  Statistically the use of a drain after breast augmentation increases the chance of capsular contracture.However excessive bleeding also increases the chance of capsular contracture  and if there is excessive bleeding the benefit of a drain to remove the blood in my opinion outweighs the risk of a drain alone.

Robert T. Buchanan, MD (retired) · Answer

There are quite a number of things that can be done to reduce the incidence of capsular contracture and use of drains is not one of them. They can, in fact, increase the risk by allowing ingress of bacteria, one of the known causes of contracture. Sub-clinical infection is, in fact, one of the main causes. That is why we irrigate with antibiotic, cover the nipple during the procedure and shield the skin from touching the implant during insertion. Other things that help are the position of both the implant and the incision, how the pocket is made, how the implant is handled and use of textured implants. Good luck with your search.

Do the use of drains help with capsular contracture?

Answers (7)

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