I'm Curious Why Some PS Use Drains on Breast Reductions and Some Don't?

Every surgeon is different when it comes to their thoughts about using drains or not using drains during breast surgery.  It depends on the procedure and a lot depends on the patient and how everything looks during surgery.  If you are making a lot of fluid during surgery, it may be necessary.  Drains are common for an Abdominoplasty and usually come out in a couple of weeks, but if there has been extreme weight loss, they may stay in a bit longer.  With that said, your Board Certified Plastic Surgeon will make the best decision for your specific procedure. Best of luck!

The use of drains should be individualized for each patient.  Drains are typically used to remove the fluid accumulation within the potential space created after the procedure, especially when tissue is removed or undermined.  They do not prevent hematomas (bleeding/blood clot formation), but may help identify them sooner.  Fluid accumulation within a potential space may cause the formation of a capsule and chronic fluid buildup in the area.  Stagnant fluid is also a good media for bacteria.  This being said, I typically do not place drain for breast reductions, as the above problems are very rare following this procedure.  For very large breast reductions, I may consider doing so, however.  For TT, there is a disruption of some lymphatic tissue, which may cause increased fluid accumulation and warrant drains.  Hope that these answers help!  Good luck!

It depends on the tissue and how it responds to surgery. Most of them time they are unnecessary but occasionally I will leave them if the tissues seem "wet."  The decision is individualized to each patient. However, I do leave them for all tummy tucks. They help reduce complication risk though when used as deemed necessary. 

The decision to use drains on breast reduction has to individualized to each patient.  For very large reductions, many plastic surgeons choose to use drains because of the increased surface area under the skin.  However, for smaller lifts, a drain is not usually necessary.  99% of the time I do not use a drain.  However, having a drain really is no big deal and really should not be a determining factor in whether or not you choose that plastic surgeon.

 

Good luck.

Both breast reduction and abdominoplasty are procedures, which involve developing flaps, resecting excessive skin and tissue and redraping the shortened skin flap.  Some physicians utilize "pain pumps", which deliver local anesthetic to the surgical plane; in these circumstances, the use of drains may be justified to prevent a "seroma" = collection of fluid under the skin flap.  Ultimately, drains aren't a substitute for a surgeon being compulsive in cauterizing any blood vessels which are cut.  Blood or serum under a skin flap needs to be treated either by reoperation or serial aspiration (extraction of the fluid with a needle through the skin).  Failure to do so can result in infection, inadequate skin retraction and or delayed wound healing.  Massive weight loss patients whose abdominal skin is excessively loose are at  highest risk for seroma. Drain use depends on a surgeon's judgment however should be combined with activity restriction and some mild surgical compression garments.  Hope this is helpful. 

There are never any absolutes in plastic surgery.  Some plastic surgeons use drains on all breast reductions while others use them only if they appear to be necessary.  On a typical breast reduction I usually do not use a drain but I do not think any plastic surgeon could be faulted for the use of a drain.  

You will find that there is no specific reason why some plastic surgeons use drains for breast reduction procedures and some do not. Having a “personal preference” in our specialty is  quite common. What you will find, however is that every plastic surgeon will swear that his/her way is the best way.

 In any case, select your plastic surgeon carefully based on  consistent safety and quality of work;  whether or not drains are used will likely not matter.

 Best wishes.

Hi

 

this is a common question. there are differences between how breast and tummy soft tissue heals. I haven't used a breast drain in 12+ years and haven't regretted it once. however, I ALWAYS use a  drain for tummies. Sometimes 2! Depends on the patient and whether additional lipo is also considered. 

The drain usually comes out at 2 weeks. everyone hates the drain, but it is a necessary issue after tummy tuck surgery. 

 

Bennett Yang, MD 
Washington DC

Dear don'tsweatit,

It is a bit confusing when different surgeons do different things, but, the more you look in to it, the more you will find that there is no absolute right and wrong with a lot of things in medicine, and especially plastic surgery.

I used to use drains with my breast reductions but I do not now.  Studies have shown that drains do not prevent haematomas (blood collection in the breast requiring a return to theatre) and I have personally found that putting the drain in can cause bleeding because you use a big needle to thread it through.

I do still use them for tummy tucks because there is a larger dead space and they help to remove the fluid from here and may help for the two surfaces to 'stick down'.  Having said that, people are starting to move away from using them for tummy tucks and it may be that we are moving that way.

The main thing is that you are happy with your surgeon, don't worry too much about whether or not he or she uses drains.  Good luck.

 Many reliable surgical studies indicate there is no need for drains with Breast Reductions unless, liposuction is performed as a component of the procedure. Many surgeons liposuction out the flanks of the breast to decrease the width. Volumes can range from 25 to 250 cc per side. We perform this component of the Breast Reduction procedure at no additional cost to our patients. Hope this is of assistance. Best,

 

 

Gary R Culbertson, MD, FACS