FTM & FTN Top Surgery Drains After Surgery

Are They Necessary?

To use drains or not to use drains? This one question has increased confusion & anxiety about surgery perhaps more than any other FTM / FTN top surgery subject. Rest assured that drains aren’t so bad, and the stakes for using them (pain, scarring, annoyance) are not as high as they are sometimes made out to be. True, drains may look odd from pictures, but their purpose and their use is actually really simple.

At The Gender Confirmation Center, the patient 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) is a medical device more commonly referred to in the top surgery world as ‘drains.’ The device draws out fluid that collects under your incisions after your surgery.   Ultimately, drains are very effective to reduce the risk of having a fluid collection under the skin after surgery.  These fluid collections are called “seromas”, and the information below will teach you more about seromas.

Seromas After Surgery

All of Dr. Mosser’s FTM/FTN top surgery techniques involve meticulous chest contouring. To ensure that the contours on the upper chest and sides are smooth and uniform, he uses a technique called undermining. 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 that 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.  It’s not the end of the world, but it’s 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 the appearance of your final result.

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 could cause additional scarring and pain, which is where the stigma against drains originates. However, Dr. Mosser’s technique does not cause any additional scarring and typically adds no discomfort to someone’s recovery.

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.

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?

People worry about extra scarring with drains, so it’s important to note that there are no extra incisions for the drainage tubes. Instead, the tubes exit the chest from the outer part of the already existing chest incision.

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 flattened and place the stopper into the bulb. This action creates the suction needed to draw out the body fluid


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

If you are not overwhelmingly anxious about drains, then you probably should use them. 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 discomfort, and although it’s 7 days of dealing with something annoying, it’s well worth it for an expedited healing process.