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Surgical Drains

 

Having plastic surgery procedures sometimes calls for the use of drains.  These drains are used after the procedure is done to remove the build up of fluids that might occur from a cavity left behind.  If these fluids are allowed to build up, then they can sometimes be the source of a hematoma / seroma, of could possibly be the source of infection.  Some surgeons decide to place a drain in your incision if there was excessive bleeding during the surgery. 

The most common procedures that are done in plastic surgery that call for the use of drains are abdominoplasty, body lifts, breast reconstruction, breast reduction, breast lifts and occasionally breast augmentations.  These drains can stay and help rid the body of the excess fluid build up for anywhere from the first 24 hours up to a couple of weeks.

A drain is simply a plastic tube with one end inside the incision and the other end leading to a plastic bulb that resembles a see through grenade.

 

                                                    Image of plastic bulb in a surgical drain

                                                 Surgical Drain - Illustration 2008 - Pam Stephan

                                              Example of Plastic Bulb in Drain

 

Most plastic surgeons want their patients to record all of the drain output in order to determine when they can safely be removed. The patient will be responsible for emptying the drains at specific time periods (both morning and evening) and be recorded.  Most of the time the period of monitoring your output in the drain is 12 hours at a time.  The morning and the evening amounts are added together to get the 24 hour total. 

Drains are normally removed after recording a 24 hour total with less than 40cc to 30cc for any particular drain. To remove the fluid out of the drains, the bulbs detach and you empty them and record the drainage. When putting the bulbs back on the tubes, you will need to squeeze them a bit to create suction. This suction helps with the drainage.   

It is not unusual to see clots, or pieces of tissue inside the tubing of the drain.  If they seem to be obstructing the drain’s flow, roll the tubing between your fingers in an attempt to mobilize it.  Any kind of flushing into the tubing should never be done in attempt to clean it.  The fluid that accumulates in the drain should be pinkish brown in color.

If the drain starts to come out, where the white portion of the tubing is showing, it is safe to push it back in until the white portion no longer shows.  The important thing to remember is if the drain should accidentally fall out completely, cover the site with gauze and call your Plastic Surgeon.  You should never try to push the drain back in.

 

 

Most patients are allowed to shower with the drains, however if your plastic surgeon tells  you not to get this area wet at all, then you will need to do ‘sponge baths’ until you have these removed.  If you have been instructed not to get your drains wet, then taking a sponge or a tub bath (with very little water), should be okay as long as no water enters the surgical site.

Some drains can be long enough to hang and lay on the floor, if not, it is suggested to wear a “belt” to pin your drains to, in hopes of freeing up your hands for showering.  These belts can be made of a bathrobe belt, an old pants belt, or even a pair of pantyhose.  There are now, places that you can buy a "Drain Belt" that can help secure the drains in a position so that you have freedom of your hands in a shower.  Submerging the drains should never be done in a bath, as contaminated water could enter the surgical site.

 

                                             Showering after surgery

                                        Licensed image for CosmeticSurgeryForums.com

 

It is very important to take all of your antibiotics that you have been prescribed.  It is easy to get a drain hole infected accidentally. Taking your prescribed medication will help ward off any infection that might occur

The longer the drain stays in, the higher the chance of infection, so be sure to take your antibiotics as directed. If you are having unusual thick discharge from the drain, please see the wound chart located under post operative complications, “Infections”.  Make sure you call your surgeon with anything unusual.

 

Please see below Wound Chart if you suspect an infection:

 

 

 

 

 

Benefits of drains for breast surgery patients:

  • Less pain in the early post-operative period

  • Minimal distortion of the appearance of the breasts early after surgery

  • Minimize post operative bruising and swelling

  • Used more commonly for sub-muscular placement than sub-glandular placement

  • No need for tight pressure dressing which often adds to the pain

  • Speed convalescent period

  • Reduce the incidence of capsular contracture with the result of softer more natural appearing and feeling breasts

 

                            Photo of Surgical Drains in Breast Augmentation or Breast Surgery

                                           2010 Copyright CosmeticSurgeryForums.com

                                                   Photo of Drains in Breast Surgery

 

 

 

Drains are normally called for in most patients who have abdominoplasty.  The purpose of the abdominoplasty drains is to decrease the risk of a seroma forming.  A seroma; is fluid that accumulates between the muscle layer and the skin flap.  Having a seroma can sometimes lead to a source of infection, so it is very important to get all excess fluid out of this area as soon as possible.  Drains serve as a point of exit for this fluid accumulation, which in turn will reduce the risks and complications that might arise from having this procedure. 

Even in abdomens that look flat after abdominoplasty there is typically some amount of fluid under the flaps, so having drains placed after surgery will help tremendously to help rid the body of this fluid accumulation.

Tummy Tuck or abdominoplasty drains are similar to the drains in breast surgery.  The small silicone tubes are inserted into the abdominal incision where the actual procedure was performed, or the surgeon might make new tiny incisions specifically for the drains. 

The tubes on the drains are connected to bulbs that provide suction for the excess fluid that accumulates during recovery.  Most surgeons ask the patient to monitor and measure the drainage each day.  The drains can sometimes only be used for the first three to five days after surgery, or it can take up to several weeks to have these removed.  Once you start noticing that the drainage that is collected is not that much, then usually it is time to have the drains removed.

As with breast surgery, you need to make sure the drains do not become clogged.  This can sometimes happen, and it is not unusual to see blood clots of pieces of tissue inside the tubing of the drain.  If the drain does become clogged, then roll the tubing between your fingers in an attempt to mobilize it.  Avoid any kind of flushing of the tubing in the attempts to clean it. Normal color of the fluid that is in the drain should be pinkish brown in color. Your surgeon will be giving you instructions on how to care for the drains during your recovery.

 

                                             Photo of multiple drains for surgical procedures: abdominoplasty and breast augmentation

                                        2010 Copyright CosmeticSurgeryForums.com

                                                      Photo of Multiple Drains

                                            Abdominoplasty and Breast Augmentation

 

 

Recovery Tips for Patients:

  • Any movement from the waist should be kept to a minimum.
  • Do not make any unnecessary up and down or twisting motions this will help to prevent any build up of fluid.
  • Normally the drains should have the fluid removed 2 to 3 times a day with the patient charting the time and amount that was in the reservoir.
  • No lifting anything more than 3 to 5 lbs. in weight after surgery.
  • As with any surgery, make sure everything you will use is sterile and clean, do not use old towels or sponges, buy new ones.  This will minimizes the risks of getting an infection.
     

     

 

Removing the drains post operatively:

  • Drains should only be removed under medical supervision.

  • The removal process is simple and normally pain free, sometimes a patient might feel a slight tingling sensation when the tubes are removed.
     

 

 

 

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