Newbie question about the drains

[rickster49]

Hello all,

New here and trying to learn more about the procedure. I to have gyno and want it gone. I'm 49 now so I've lived with being covered up by dark or thick clothes long enough. The worst is going swimming, which is a whole production of waiting for the right moment in my mind when I think not to many people will see my chest, jump in the water and always stay in the water up to my neck. Then be sure to have a big towel close by to put over my neck and drape over my chest when I get out of the water. I'm sick of it!! I've tried many diets and exercise to no avail, so it's time for a positive change in my life!! I have plenty of questions though that I hope you guys can answer. First thing I'd like to know is what the drains are for? Are they for fluid left by the surgeon or is it for internal bleeding or something else? Also it seems not everyone has drains after the surgery. Is this because of the amount of tissue removed or is this a surgeons technique?
Thanks for the help!!!

[fluffy_tits]

drains are for the fluids left in a person.   If the surgery isn't big  you won't need drains.






Fluffy( o )v( o )...

[D24]

HI rickster,

I had excision only recently and had drains in for 24 hours. I was told it is down to a couple of factors:

1. Surgeon's personal choice
2. Depends on how the surgery goes

My surgeon personally prefers to use them and he said it speed the healing process up as rather than leave blood/fluid to build up it's drained away. I noticed in my drains it was a kind of reddy yellow colour which i believe is a mixture of blood and serous fluid.
Personally i think its a good thing to have, it will mean an extra tiny incision but i think it's worth it.

[DrBermant]

Hello all,

New here and trying to learn more about the procedure. I to have gyno and want it gone. I'm 49 now so I've lived with being covered up by dark or thick clothes long enough. The worst is going swimming, which is a whole production of waiting for the right moment in my mind when I think not to many people will see my chest, jump in the water and always stay in the water up to my neck. Then be sure to have a big towel close by to put over my neck and drape over my chest when I get out of the water. I'm sick of it!! I've tried many diets and exercise to no avail, so it's time for a positive change in my life!! I have plenty of questions though that I hope you guys can answer. First thing I'd like to know is what the drains are for? Are they for fluid left by the surgeon or is it for internal bleeding or something else? Also it seems not everyone has drains after the surgery. Is this because of the amount of tissue removed or is this a surgeons technique?
Thanks for the help!!!

Drains are devices to remove excess fluid from the surgery site or to hold the open space together with suction.  They can be uncomfortable, need to be taken out (some additional discomfort), can be a source of infection needing additional antibiotics, slow healing, and often need an additional incision. 

Drains can be essential for patients who have problems during surgery and can help drain a collection of blood as in a  Hematoma Complication.

For these reason, I prefer techniques that minimize the use of drains unless they are needed (about once every 2 years for my male chest sculpture.) Some surgical methods tend to damage tissue more leaving fluid to drain. Not all doctors use the same techniques nor have the same skills and therefore need drains more often. 

The pictures of drains I use are of a Tummy Tuck. For that sculpture, compression garments do not have the bone rib cage to compress against so I still use drains for that type of sculpture.

Hope this helps,

Michael Bermant, MD
Learn More About Gynecomastia and Male Breast Reduction

[krucial]

go for it man! finds a experienced surgeon in gynecomastia... No drains for me, when i had procedure last week! It ass depends of the amount of work,  more likely if you have a big case.
So many people have it done, nothing u should worry about.. walk in the park!!!! they say... just gotta stay patient



good luck to you!

krucial

[rickster49]

Wow!!

Thanks to all you guys and Doctor for the fast responses.  From reading the replies it seems that the drains are more of a surgeons choice based on various factors. I'll keep lurking around these boards and exploring Dr. Bermant's web site to learn more about gyno. I'm sure I'll have more to ask soon.

Thanks again!

[Dr. Elliot Jacobs]

Drains are used as a type of "safety valve" -- they function to remove any fluid or blood that may accumulate after surgery.  Since drains also apply a low grade suction, they help keep the skin tight against the underlying tissues so that healing can proceed.

Surgeons use drains according to their own particular training, experience and what has transpired during surgery.  But they can also cause some problems:  just as they can allow fluids to drain out, they can allow germs to walk in.  Therefore, continued antibiotics are needs while drains are in place.

In my practice, I used drains roughly in 1-2% of my cases.  And then remove them as quickly as possible --usually 1-3 days after surgery.  I am able to minimize the use of drains by doing a lot more removal of tissue with my own specially designed cannula, which can remove both fat and breast tissue. If indeed I do have to make an incision to remove remaining breast tissue directly under the nipple (and I do not hesitate to do so if necessary), then there is less potential open space -- which makes the need for a drain less necessary.

You should discuss the use of drains with your surgeon so that you understand in what circumstances they will be used.  There is absolutely no right or wrong in using drains -- no matter what, trust that your surgeon will use his best judgment in deciding about their use.

Good luck!

Dr Jacobs

[DrBermant]

Wow!!

Thanks to all you guys and Doctor for the fast responses.  From reading the replies it seems that the drains are more of a surgeons choice based on various factors. I'll keep lurking around these boards and exploring Dr. Bermant's web site to learn more about gyno. I'm sure I'll have more to ask soon.

Thanks again!

You are welcome. Yes, there is a massive amount of information on my website.  I believe an educated patient is an essential component to a successful outcome. Results you see on my website are typical for my patients and technique. 

Another important issue for my extremely low need for drains, the minimal bruising and swelling is:

No Blind Cutting of Tissue such as gland "removed" with remote cutting tools. Cutting under direct visualization, then control of bleeding permits such low Bruising and Swelling After Gynecomastia Surgery that I can post typical early after surgery pictures.  The only way you will see such early results usually for other doctors' patients is a forum like this.  Many other techniques have such swelling and bruising that doctors do not post such pictures on their internet sites. 

I work hard on this internet introduction, my typical patient tells me that their experiences were like or better than what they found on my website.

Hope this helps,

Michael Bermant, MD
Learn More About Gynecomastia and Male Breast Reduction

[Miguel Delgado]

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.  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, Jr., M.D.
415-898-4161
www.dr-delgado.com
www.gynecomastiaspecialist.com