Drains or no drains after breast augmentation? Prevention of CC continued.

Hello,Drains have no purpose in primary breast augmentation. In fact, as time goes by and techniques are perfected, drains are finding less and less utility in many plastic surgical procedures. With regards to breast augmentation, there should be no pooling of blood, but if there was an accumulation of blood, drains wouldn't be effective anyway because of clotting within the drainage tube. The other reason drains are not needed for breast augmentation is the risk of bacterial contamination of the implants. In summary, they don't remove blood or fluids, and they potentially expose implants to bacteria.  Both blood and bacteria are important in the pathogenesis of capsular contracture.If you are interested in risk reduction of capsular contracture, you should find a surgeon that adheres to evidence based practices:1. bio-dimensional planning of implant size2. inframammary incision3. all electrocautery dissection4. triple antibiotic/Betadine irrigation5. funnel delivery of implant (no touch technique)Best of luck!

Hi... thank you for the question... this would depend on the PS criteria, in my practice i do not leave drain after a breast augmentation.

I like to avoid the use of drains in breast augmentation in most cases. The reason for this is that the drain does represent a portal for possible entry of bacteria into the implant pocket. I prefer to be meticulous in my hemostasis and apply a postop bra with gentle compression. Accumulation of blood does seem to be related to increased risk of capsule formation. However a drain may not prevent this anyway.In some cases I may use a drain such as in a complex revision case with the use of dermal matrix.Good luck

Hi, I don't use drains after primary breast implants as they offer no substitute for careful dissection and hemostasis (achieving a bloodless field) hope this helps warm regards Dr Prashant Murugkar

There is no evidence that the use of drains helps prevent contracture.   I do not use them for breast augmentation procedures but do use them often for revisionary breast cases. Best wishes.

Most 'modern' surgeons would not use drains for breast enlargement. Drains were popular many years ago when the pockets for the implants were mainly created by smooth dissection (I.e. with the surgeon using fingers instead of surgical instruments, pulling and pushing the tissues apart). Nowadays most surgeons would use accurate sharp dissection, careful haemostasis and a strict 'no-touch' technique. The difference between the two techniques is that in the first case it is not generally possible to achieve perfect haemostasis and a dry pocket, which creates the need for drains.Some surgeons still use smooth dissection and drains, and do get good results. At the same time drains are uncomfortable, and potentially increase the risk of infection. There is no evidence that drains reduce the risk of capsular contracture.There is no way, in my opinion, to present drains as an advantage for the patient, and I would suggest to go with a surgeon that doesn't use them.

Drains are not routinely used in primary breast augmentation as they don't appear to benefit most people and add a potential conduit for infection of an implant from the environment. Some surgeons have made the case that drains may be of benefit for reducing seroma (fluid collection) in cases involving textured implants, but that is not widely practiced in either the US or in the rest of the world (where textured implants are used more frequently). In procedures involving a revision where a prior capsule is removed, I will drain due to the amount of raw surface produced (which tends to ooze more). On breast augmentation combined with a lift (mastopexy), I will drain selectively depending on the complexity of the procedure.

Prospective hemostatsis (preventing bleeding as you do the surgery) is the best way to prevent avoid blood in the space around the implant.  Yes, there are theories that blood pooling may be a factor in capsular contracture.  But bacterial contamination may also be a cause of capsular contracture and using a drain when it is not necessary will increase that risk.  I do use a small drain for a short period in some revision cases where I use acellular dermal matrix, however.  Good luck!

Blood is certainly a factor in the formation of capsular contracture as well as inflammation and pain following surgery...The use of atraumatic and well visualized surgical techniques to carefully ensure hemostasis and minimal bleeding I feel are very important to an excellent breast augmentation outcome with limited complications and discomfort. That being said I am against the use of drains.  They are uncessesary in my practice with the aforementioned techniques and are a potential source of contamination of the implant from the outside environment.  Warm regards,Dr Quinton Chivers MD FRCSCPlastic and Reconstructive Surgery

Thank you for your question and drains are not routinely used in primary breast augmentations as they add no benefitDr Corbin