Drains after surgery

[Cpnh78]

How long do drains stay in for? I know it can be different for everyone, but what is the normal time? Does it hurt to have them removed?

[sunnyUK]

For me mine were taken out after 18 hours, very little pain.

[Dr. Elliot Jacobs]

I very rarely use a drain -- but in the 1 in 100 cases in which I do use them, I try to get them out within a day or two after the operation.

Dr Jacobs

[Cpnh78]

Dr. Jacobs, what are the reasons that cause that 1 in 100 chance that you use a rain?

[Dr. Elliot Jacobs]

what are the reasons that cause that 1 in 100 chance that you use a rain?

A drain is a plastic tube which is left in place under the skin in the area of surgery and which exits the body through a small hole in the skin.  The outside end is usually attached to a squeezable bulb (surgeons call it a "grenade" because it looks like one) which exerts a sucking effect, much like a straw.

Drains are used at the discretion of the surgeon -- there is no right or wrong as to whether they are used 100% of the time or very rarely.  It depends upon what transpires during surgery as well as the surgeon's training and experience.  Certainly there is absolutely no harm in using a drain -- it can be construed as a "safety valve" to remove any fluids or blood which might accumulate after surgery and prevent proper healing.  On the other hand, I believe they are not necessary in every case.

Drains may be left in place for a day or two (my personal preference) or much longer if the surgeon feels it is necessary.

In my personal experience, I know that drains can be uncomfortable and at best annoying to the patient.  They can be very uncomfortable when they are removed.  Drains can also potentially serve as an entry point into the body for bacteria -- ie drains are a two-way street.  Therefore, the surgeon must make a decision at surgery as to whether the positives outweigh the negatives.

I have found that with my own personal gynecomastia techniques, drains are rarely necessary.  First, most of my work is done with aggressive liposuction utilizing cannulas which I designed myself.  Therefore, there is a resultant large meshwork of tissue left, instead of a huge open space between the skin above and muscle below -- which has the potential to allow fluid accumulation.  Next, I am scrupulous in stopping even the most tiny bleeding blood vessel -- this takes time and patience.  And finally, I believe in very firm post-op compression for at least one month.  This includes several layers of compression garments -- not just a vest.

In the rare cases that I use a drain, most of them involve men who have used anabolic steroids and have huge amounts of extremely solid tissue which my cannula cannot remove. This will then require scalpel excision which will leave a large space between the skin and the muscle and which could potentially accumulate fluid.  The only other cases are ones in which there is  an unacceptable amount of oozing during the operation -- sometimes due to the fact that the patient ignored my instructions not to take aspirin prior to surgery.  Aspirin interferes with the blood's ability to clot and makes surgery very challenging.

A simple question -- and some very complicated answers.

Dr Jacobs

[Cpnh78]

I appreciate you taking the time to answer the question so thoroughly.  I have not heard of the multiple compression garment philosophy before. It makes sense.

[soledad829]

I had drains after my surgery a few weeks ago.  I was a little worried before the surgery since I knew I would probably have them.  But it wasn't a big deal.  They were easy to drain and they came out about 5 days later when the drainage had been reduced.  It's no big deal!