When it comes to operative technique, few topics have had as much controversy as drains in plastic surgery. From my perspective in Columbus, Ohio, there are the “drainers” and the “no-drainers,” and both sides have taken a position and have a line in the sand, just begging for you to step over. But why is this the case? Can’t we all just agree on whether you need a drain after plastic surgery?
In reality, each plastic surgeon has their own technique and experience, which plays into the decision. And of course, each operation is different since every patient is unique. In this blog, I will explore some of the history of drain use in plastic surgery and discuss my rationale for why I think it is a no-brainer to be a drainer!
Why Do Plastic Surgeons Use Drains?
For those who are not familiar with drains, these are small plastic tubes placed in the operative field—face, breast, or abdomen—to remove fluid build-up after surgery. The fluid is a mixture of blood and lymph fluid, and we call this mix a serous fluid. When it collects into a larger amount, it is called a seroma. The tissues knit back together faster when there is no fluid separating the two layers. The drains remain in the patient, in the operative field for a few days, or even longer for some operations, like a tummy tuck. For many patients, they are cumbersome and uncomfortable.
This has motivated some surgeons to figure out a way to eliminate the need for drains. About 20 years ago, a plastic surgeon friend of mine in Texas started using sutures to close the two layers on the tummy tuck and coined the term Progressive Tension Sutures (PTS). The concept was to make the layers heal faster by suturing them together, eliminating the need for drains.
What Is Better: Drain or Drainless Tummy Tuck?
I was at one of the earliest conferences where the idea of a drainless tummy tuck was presented, and I decided to adopt this technique for a few years. I found that the majority of patients developed seromas, and I was faced with managing these in the clinic by draining them with a (BIG) needle, often multiple times on the same patient over a period of a few weeks. Therefore, I concluded that the drainless tummy tuck was not beneficial for most patients.
Do You Have Drains After a Breast Reduction?
For breast reduction surgery, the same scenario played out. The drainers versus the no-drainers have taken sides, and it seems there is no way to reconcile this controversy. The no-drainers point to a few studies that show no increase in complications when drains are not used. However, the devil is in the details, and the studies were done many years ago, with a different technique for the surgery.
In my surgical technique, the lower part of the breast is removed, and this empty space collects the fluid for the first few days. This can lead to wound healing complications. For this reason, I still use drains, for about 2 days on breast reductions. Again, Nurse Vickie will report that we are better off now with drains than when we avoided drains during breast reductions.
Some plastic surgeons perform breast reductions differently, leaving the bottom breast tissue and removing the top and side breast tissue. This technique is called the inferior pedicle technique. I feel the shape of the breast is better with my technique, which is called the superior pedicle technique, but I do feel there are benefits to using a drain.
Do You Need Drains After a Facelift?
And then there are the facelift surgery drainers and no-drainers. This area also has plastic surgeons on both sides of the debate. Again, I feel the short-term inconvenience of the drain is worth the long-term payoff of having facelift patients heal faster with less swelling and bruising.
Keep in mind the practice of plastic surgery is constantly evolving along with each surgeon’s expertise and experience. While we all would love to have a uniform yes or no answer, that’s simply not realistic. Each surgeon brings their own training and technique to your procedure, much like each athlete has their own set of skills. The best outcomes are achieved when an experienced plastic surgeon utilizes her own skills and knowledge and becomes a master at her craft. Over the last 25 years, I have refined my surgical skillset, and continue to bring all of this with me to the (operating) table.
It’s true that drain usage is one of the most controversial topics in plastic surgery. However, it is a no-brainer to be a drainer! This approach provides my Columbus plastic surgery patients with the best results and recovery experience.
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