Are drains always necessary after breast explantation with capsulectomy and breast lift?

The use of drains is operator dependent. Some use them while others do not. There are no absolutes. That being said, there are some cases where there is more of a consensus. Drains are placed to mitigate the risk of fluid collections especially in the cases where there is "dead space" or void after tissue or implant removal. Thus the potential indication in the setting of explant.As always, discuss your concerns with a board certified plastic surgeon (ABPS).Donovan Rosas MD
Board Certified by the American Board of Plastic Surgery
Member: American Society for Aesthetic Plastic
Surgery, American Society of Plastic Surgeons
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Dear gvasilyeva,
drains are used to prevent hematoma and seroma formation after removal of implants, Their use is based mostly on intraoperative findings and previous experience. If you are considering a surgery, I would suggest you to consult a board-certified plastic surgeon. Only after a thorough examination you will get more information and recommendations.
Daniel Barrett, MD

Hello! Thank you for your question! It is a matter of surgeon preference as well as what is seen during your procedure that will determine whether or not a complete capsulectomy is performed. I have always favored a complete capsulectomy vía en bloc method.  Although a more complex and skilled procedure, I believe it to be the best method, especially given concerns today  A true en bloc will keep the implant and all contents within as one piece throughout the removal without violating the capsule and opening it up during the procedure.  
If significant capsule formation is seen intraoperatively, a full capsule removal may be warranted with a drain in order to completely remove all of the tissue and allow better adherence of your breast back to its normal anatomic position down on your chest wall. If minimal contracture is seen, it may be possible to leave the capsule, or place cuts within the capsule to allow better adherence.  It is still not completely understood what forms the capsule, but the popular theory would lead most to removing it entirely. It truly is dependent on what is seen with your capsule and the issues that may be causing you to have such a procedure (e.g., contracture from rutptured implant vs pain vs simple pocket adjustment, etc).  
But, I completely believe in removal of the entire capsule, en bloc, for several reasons - removal of entire capsule that wasn’t there to begin with, adherence of tissue back to where it started, improved breast contour for revision, and not exposing the body to any implant material or periprosthetic fluids/contents that are within the capsule and in vivo.  These are just a few important that en bloc addresses. Drains should be used to remove the fluid that will inevitably develop in the potential space.   Without knowing your issues and without an examination, it is difficult to tell you what may be the best thing for you. I favor performing capsulectomies (in an en bloc fashion) in order to create a fresh pocket, reshape the pocket, allow better shape and adherence of the overlying breast, and suturing the muscle back to where it started from. I would discuss your issues with your plastic surgeon who will assist you in determining the right modality for you. Given the capsule formed from the foreign object and was not there to begin with, as well as some theories of what exactly is a capsule and what causes it to form...I favor complete capsule removal.  I would expect a somewhat similar appearance as if you have not had implants, as your breasts have also aged over the past few years. The decision on whether a lift may be performed depends on how much of a lift is needed and ultimately vascularity to the breast.  Otherwise, consideration as a staged procedure with/out fat grafting may be done then or at same time.  Most are back to regular things within a week. Activity restrictions for ~6 weeks along with a compression bra.  Cost will vary amongst surgeons. Discuss with a surgeon who is knowledgeable, skilled, and experienced with this technique. Hope that this helps!  Best wishes!

Great question!  Drains are frequently used but not always necessary during a capsulectomy.  If a surgeon is truly doing a full capsulectomy, there can be a lot of drainage and you don't want this building up inside your breast cavity.  Often times its a decision that is made during surgery depending on how much bleeding there is.  Especially with a breast lift there could be more drainage than the body can absorb in a given time.  However, this is surgeon dependent and I would have a detailed discussion with the surgeon you decide to proceed with.Best of luck and hope this information helps!
- Dr. Roger Tsai  @DrRogerTsai
Board Certified Plastic Surgeon

Drains may assist in reducing the risk for fluid collection in this scenario (breast explanation, capsulectomy, breast lift).Kenneth Hughes, MD, ABPS Board Certified Plastic SurgeonLos Angeles, CA

Hello, and thank you for your question. (Keep in mind that an in-person consultation is necessary for the best advice.) It is not uncommon after such extensive surgery for a plasic surgeon to place drains. The dead space and the potential for fluid accumulation are the reasons. If you decide to pursue surgery it’s very important that you find a surgeon whom you are comfortable with and trust and who evaluates you in-person and tailors an individualized treatment plan for you and your aesthetic goals. Best of luck!
Matthew A. DelMauro, M.D.

Thanks for your question! Drains are only placed when a surgeon is concerned about the potential formation of fluid build up (like seromas or hematomas). With explants + a lift it really comes down to surgeon preference, the level of tissue trauma (hard to remove capsule, problematic implant, lots of tissue manipulation with the lift), and how much you tend to bleed/swell. I hope this helps and best of luck! 

The decision to use drains is up to the physician and what they are comfortable with.  I do not routinely use drains in anything other than a tummy tuck, but if I do a case where there is more oozing (low level bleeding) than expected, I would not hesitate to use a drain on a single side.Some physicians use drains on all breast cases and this is not unacceptable.  It is dependant on their training and level of comfort.Dr T

Thank you for the question. Keep in mind that practices will vary; the information you receive here may not be relevant when it comes to exactly what your plastic surgeon protocol is. In my practice, I do use drains for all patients who undergo breast implant removal surgery. This maneuver with fluid removal (and helps prevent seroma formation). Drains are typically removed within one week after the procedure; in our practice, the use of local anesthesia helps make there removal as painless as possible.
 Generally speaking, breast implant removal surgery is a very well-tolerated procedure typically  associated with much less discomfort and medication requirement for postoperative medications ( compared to the initial breast augmentation procedure).
 I hope this helps.

Hi and welcome to our forum!
Drains are utilized after an operative procedure if excessive drainage is expected to prevent blood from collecting beneath the flaps following the operative procedure. Capsulectomy can often cause significant oozing of blood. It is a prophylactic measure to prevent the necessity of a secondary surgery to drain the blood, which would otherwise result in impaired healing, infection, etc.
Some capsulotomies are bloodier than others.  There is no hard and fast rule regarding the use of a drain. It is a decision that is made during the procedure based upon the appearance of the operative field. Not all capsulotomies require the use of a drain.
Best wishes...