Are drains necessary after gynecomastia surgery?

[Andgy]

I have heard that some surgeons use drain tubes to reduce hematoma after a gynecomastia surgery.

However, some other doctors feel they are unnecessary and may even leave behind some scars.

What are your views on this?

Thank you.

[Dr. Cruise]

Hi Andgy,

Thank you for posting your question. I personally do use drains with all of my gynecomastia patients to reduce the risk of a hematoma/seroma and to aid with the skin adhering back down. The incision is very small and hardly detectable once healed and well worth the trade off. 

[Andgy]

Thank you Dr. Cruise for your kind reply.

[Miguel Delgado MD]

I think this is the personal choice of the surgeon, however, I always used drains.  The purpose of drains is not to prevent hematomas because the drains do not. It does, however, remove tissue fluid and normal post-op bleeding and creates a vacuum for the skin. It can certainly prevent a seroma. The drain can and does create scar tissue especially if left in too long but this is temporary.  I have found that placing the drain through a small incision in the axilla hair area and placing a light suture to hold the drain mid-way up from the fold is the best approach that minimizes scarring.  I avoid the drain at the base near the fold completely because it can cause prolonged swelling.

[Dr. Schuster]

Drains are used in many different types of surgery. They are used to remove fluid and/or blood. This allows the tissues to heal quickly because the surfaces of the "wound" begin to stick together without something between them. While this helps to understand why surgeons use drains, all surgeons know tat drains do not prevent hematomas. Hematomas occur when there is brisk bleeding after the surgery and in general overwhelm the drain and the blood collects. I use the Lateral Pull Through technique most of the time for te correction of gynecomastia. This technique does not require the use of a drain. 

[Andgy]

Thanks for all the explanation.

So it seems putting drains after the surgery is the preference of the surgeon.

i have another "classic question": Why do some surgeons prefer general anesthesia when it has been proven IV sedation (or twilight sedation) is sufficient to successfully perform the operation?

I know in some rare instances, some doctors only use local anesthesia but I have read horror stories of patients feeling immense pain or discomfort afterwards.

[Dr. Elliot Jacobs]

I very rarely use a drain -- only in cases when there may be some oozing that I am concerned about.  A drain will not prevent a hematoma -- I have seen cases of hematoma with a drain in place.

As for anesthesia, I prefer sedation (not general anesthesia) provided by an anesthesiologist plus local anesthesia which i inject.  I makes for an easy experience for the patient without much of the nausea and vomiting which can follow general anesthesia.

I do not do pure local anesthesia -- much too painful for the patient.

Dr Jacobs