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 get along? Can’t we all just decide which way is best—for the patient and the outcome?
It would seem that with enough research we could come to a conclusion that we could all live with, but this has not occurred. Instead, each plastic surgeon has their own technique and own 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 continuing to be a “ drainer”—and 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 are placed in the operative field—face, breast, or abdomen—to remove fluid that builds 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 on some operations, like a tummy tuck. For many patients, they are cumbersome and uncomfortable.
So there has been motivation to figure out a way to make the drains unnecessary and eliminate their use. About 20 years ago, a plastic surgeon friend of mine in Texas started to use sutures to close the 2 layers on the tummy tuck and coined the term Progressive Tension Sutures- PTS. The concept was to make the 2 layers heal together faster by suturing them together, thereby eliminating the need for drains.
What Is Better Drain or Drainless Tummy Tuck?
I was at one of the earliest conferences where this drainless tummy tuck idea was presented, and I decided to adopt this technique. For a period of a few years, I tried not using drains on my tummy tuck patients. There were a few that did not develop a seroma but most did, and I was faced with managing these in the clinic by draining it with a ( BIG) needle, often multiple times on the same patient over a period of a few weeks.
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 the 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 the part that is removed, and this empty space collects the fluid for the first few days. This can lead to issues with wound healing. And 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 the time we tried not to use drains on the breast reductions.
There are some plastic surgeons who do the surgery a different way, leaving the bottom breast tissue and removing the top and side breast tissue on their breast reductions—this technique is called the inferior pedicle technique. I feel the shape of the breast is better with my technique—called the superior pedicle technique, but I do feel the need to use 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. Again, I feel the short-term inconvenience of the drain is worth the long-term payoff of having the facelift patients heal faster with less swelling and bruising.
If this blog has made you more confused, don’t despair. The practice of medicine and plastic surgery is constantly evolving along with each surgeon’s expertise and experience. While we all would love to have a certain yes or no answer, that is not the reality of it. Each surgeon has their own personal technique, much like each athlete has their own set of skills. In plastic surgery we agree on many things, but also disagree on many things because there is no one correct answer. The best outcomes are when the experienced plastic surgeon utilizes her own skills and knowledge and becomes a master at her craft. Over the last 25 years, I have worked to do this, and 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. I think it is a no-brainer to be a drainer to give my Columbus plastic surgery patients the best results and recovery experience possible.