Chest Reconstruction  Top Surgery and Drains

Are They Necessary?

To use drains or not to use drains? This one question has increased confusion and  anxiety about surgery perhaps more than any other chest reconstruction top surgery subject. Rest assured that drains aren’t so bad, and the stakes for using them (pain and annoyance) are not as high as they are made out to be. 

At The Gender Confirmation Center, the patient generally gets to decide if they prefer drains for double incision surgeries, but drains are required for any other procedure types such as keyhole and periareolar surgeries.

What Are Drains and Why Are They Used?

The Jackson-Pratt (JP) drain is a medical device more commonly referred to in the top surgery world simply as ‘drains.’ The device draws out fluid that collects under your incisions after your surgery.    Drains are very effective to reduce the risk of having a fluid collection under the skin after surgery, also called a “seroma.” 

Seromas After Surgery

All of our surgeons’ chest reconstruction  top surgery techniques involve meticulous chest contouring. To ensure that the contours on the upper chest and sides are smooth and uniform, our surgeons use a technique called undermining (warning: the link contains an intraoperative photo). When a lot of undermining is performed, there’s a possibility that the area can fill with fluid after surgery.  The ‘fluid’ is exactly like the fluid that would appear on your knee if you skinned your knee very hard.  It’s one of the ways the body heals. Sometimes there’s enough fluid produced into a healing area that it becomes an actual gathering of fluid under the incisions, and this is a seroma.  A seroma is not a serious complication, but it can be  an inconvenience during your recovery.

Treatment of small seromas: A small seroma doesn’t always require medical treatment. The body may naturally reabsorb the fluid in a few weeks or months.  However, even small seromas will lead to much longer swelling in the area of weeks to months.

Treatment of larger seromas: If a larger seroma develops it may require drainage of the seroma in the doctor’s office. This process is completed by numbing the skin, inserting a needle and drawing out the fluid.  It can take 2-4 weekly visits to get to the point that a seroma will not return.

Consequences of a seroma: Seromas can be tight, uncomfortable, and they can delay the disappearance of your swelling by weeks or months. However, seromas are not likely to change your final outcome. 

Prevention of seromas: The chance of having a seroma can be greatly reduced by utilizing drains and compression garments.

Pros and Cons of Drains

Why don’t people like drains?

The placement of drains may cause additional scarring and pain, which is where the stigma against drains originates. However, our surgeons’  techniques do not cause any additional internal scarring. The only visible scarring that may result from drains would be very small scars under the arms for someone undergoing a minimally-scarring procedure, and no additional scarring at all for patients who opt for double incision, buttonhole or fishmouth procedure types. The discomfort that drains cause are minimal and generally, the benefits outweigh the inconveniences.

Do they hurt?

The placement of drains is intended to limit discomfort, healing complications, and scarring. The way our surgeons place the drains usually makes them pain free, or they may cause only minor temporary discomfort.

Are drains annoying?

Yes, they can be annoying for a week, but well worth it for preventing a considerable inconvenience of a fluid collection and a delay in recovery. Remember that they are removed after 7 days.

Do they cause extra scarring?

 As mentioned above, here are no extra incisions for the drainage tubes for those who undergo a double-incision, buttonhole or fishmouth top surgery. Instead, the tubes exit the chest from the outer part of the already existing chest incision. For a procedure with minimal scarring (eg, periareolar or keyhole), there will only be very small scars under the arms, right below the armpits, from where the drains are inserted.

Making The Final Decision

How do drains work?

When the bulb is compressed (squeezed) with the stopper in place, a constant gentle suction is created. In order for the drain to draw fluids away from the surgical site, the bulb should be compressed at all times (unless you are draining the fluids).

How to empty your drains

  • About 2-3 times a day, the fluid will need to be emptied from the reservoir.  The detailed video below will show you how to strip your tubing and empty your drain system.
  • The fluid will be emptied into a cup that is marked with milliliters. Record the ml amount each time using this drain log.
  • After emptying the fluid, remember to squeeze the bulb until it is flat and place the stopper into the bulb. This action creates the suction needed to draw out the body fluid.

Who

  • Either you, or someone who is caring for you, can empty the drains. It should take about 15-30 seconds per drain. The nurse will teach you to do this before you leave the surgery center or hospital.

What should my fluid look like?

  • The color of the fluid is not important. It is usually bloody in the beginning with a dark red appearance.
  • As your incisions heal, the fluid changes to light pink, then yellow, and finally clear.

When can I get my drains removed?

Drains are typically removed when the fluid output is below 30 ml for more than 2 days in a row. They are almost always removed by day 6 or 7 after surgery.

Contact us if any of the following occurs:

  1. Fever greater than 101
  2. Bulb doesn’t hold suction (make sure the emptying cap is closed securely)
  3. Tubing falls out of the body

Final Thoughts on Drains

We usually recommend our patients opt for drains.They will help you have the most reliable recovery possible. If you do opt for drains for double incision, remember that there are no extra incisions for the drainage tubes. Drains do not usually add any or very minor discomfort, and we believe they are  well worth it for an expedited healing process.