Breast augmentation and mastopexy with prosthesis without drains
Since 2016 we have not used aspiration drains in aesthetic breast surgery. Below we will explain why.
Whether or not to use aspiration drains in the postoperative period after breast augmentation or mastopexy is an old debate that dates back to the 1980s. There are arguments for and against using them. We will review the most frequently commented ones:
IN FAVOR OF USING DRAINS:
- Surveillance of the surgical space : Drains would serve to warn of bleeding before it was clinically evident.
- Remove fluid and blood from the surgical pocket : Blood could be a breeding ground for bacteria.
- Minimize the risk of rotation of anatomical implants : By reducing the accumulation of blood and fluid in the surgical pocket, the anatomical implants would be better fixed to the tissues and would rotate less.
All three arguments have strong defenders but it has not been possible to scientifically validate any of them. Drains have not been proven to prevent hematomas since as soon as a blood clot forms, the drain is unable to evacuate it. In addition, sometimes there may be bleeding from the drain without internal bleeding or hematoma occurring; it is enough for the drain tube to suck in a small blood vessel that otherwise would not have bled. No lower risk of capsular contracture or infection has been scientifically demonstrated in any study (in fact, in some studies there has been a higher risk) or lower risk of rotation of anatomical implants.
AGAINST USING DRAINS
- One more unnecessary scar on each breast.
- Theory of increased contamination : Since the exterior is connected to the interior of the surgical pocket, there is a theory that it could increase the risk of infection, in the same way that a bladder catheter increases the risk of urinary infection.
- Increased pain
The theory of greater infection is suggested by a scientific study in which there were more infections in the group with drains. It is not fully proven and very possibly not true. The drainage is used for just a few hours, in principle insufficient time to generate bacterial contamination. The scar is tiny, practically invisible.
The most recent scientific studies, from the end of 2015, confirm that there is no proven difference between installing drains or not installing them. In fact, the authors of the latest study say: “Based on the paucity of favorable evidence, the authors do not use drains in augmentation patients, and rely on surgical hemostasis to prevent hematoma formation. Understanding the Etiology and Prevention of Capsular Contracture. Anand K Deva. Clinics of Plastic Surgery”
Therefore, seeing that there are no differences between using them and not using them, we decided to stop using them to avoid the associated pain and discomfort. Since we do not use suction drains we have the perception that our patients experience less pain and discomfort.