THE CONTROVERSY OF DRAINS
Drains are a surgeon’s choice based on his procedure. There is no right or wrong answer. Each surgeon must deal with the outcome and complications of “drain or not to drain”.
I drain! The surgery that I perform for the average gynecomastia patient is an aggressive and wide exposure approach. This creates a large area of “dead space” or open space. This pocket has a large area of “raw space”, which loves to ooze fluid. A drain will collapse the space, evacuate the fluid and create a negative pressure to the cavity, which encourages it to close down. The addition of the compression garment creates a perfect environment for healing.
Early in my career, I used drains based on the complexity of the case. Greater than 10% of the time, I had fluid accumulation inside the dead space area. This is called a seroma, not an accumulation of blood, but of yellow body fluid. This complication is easily corrected by needle aspiration every four to five days until the cavity is collapsed. But, it is very inconvenient for patients. Also, there can be prolonged healing. In the end, all works out perfectly if the complication is dealt with properly.
I have learned from my experience over twenty years. I drain all cases, except those that are candidates for the “Light Procedure“. Allow me to explain further.
The drainage output allows me to see what is going on inside! By the consistency of the fluid, thickness, and the speed at which it is coming out, it can alert me and my staff to:
• Let’s observe him longer in the recovery room.
• Let’s take off the garment to see if swelling is occurring due to a blood accumulation.
• The fluid is thin. Great! All looks good.
As a surgeon, this gives me valuable information.
I see many patients from out of town. They need to heal uneventfully.
My seroma or fluid accumulation rate is near zero. However, there is a price or tradeoff! The small scar from the liposuction or drain site has been a point of concern for patients. Sometimes, it is more obvious than the incision around the areolae for glandular excision. My patients have educated me about this over the years and now I have an instrument to take the incision high up in the armpit and go towards the back. Listening to your patient is the most valuable thing in a plastic surgery practice. This is a win-win situation. I get my drain and the patient’s have to search for their drain incision!
Miguel A. Delgado, M.D.