Surgical Drains Demystified
Many of my patients are understandably concerned when I tell them they may need to have a drain after their surgery. There are concerns about how they work, how long they will need to remain in place, how they will be concealed, and how they are removed. They are commonly used after tummy tucks, facelifts, and certain breast procedures.
A drain is a thin rubber tube that stops fluid and blood from collecting under the surface of the skin. The fluid collects in a compressible bulb-shaped device that attaches to the thin tube. The negative pressure created by compressing the bulb helps the fluid to drain.
One of the most common drains is called a Jackson-Pratt. The portion of the drain that you will see is a clear tube that is about 0.25 inch thick. The drains are usually sutured in place so that they cannot accidentally fall out if you move the wrong way. Tummy tuck drains are typically sutured into one of three locations: the hair-bearing skin (mons), within the surgical incision, or just to the side of the incision. Facelift drains usually are placed behind the ears. Breast surgery drains emanate from the surgical incision, just to the side of the incision, or the underarm.
The drains are easy to manage. The fluid is emptied from the bulb and placed in a measuring cup. You will be given a “score sheet” so that you can keep track of the daily drain output. The only care that is necessary is keeping the area where the drain emanates from the skin, clean and covered with a gauze pad.
The number of drains depends on the extent of the surgery. Tummy tuck and breast surgery patients typically have 1-2 drains depending on the amount of tissue removed and if they had other procedures performed at the same time (i.e., liposuction). Tummy tuck drains usually remain in place from 5 to 14 days. I usually wait until the drains have an output of no more than 30 mL (1 ounce) per day before removing them. Facelift drains usually stay in overnight or just 2 days, and when required, breast surgery drains usually are removed within a week.
The drains are removed in the office during a routine office visit. Anesthetics are not required for their removal. Patients may experience mild and brief discomfort when they are removed. Drains that stay in longer may be felt more than those that are removed sooner.
After the drains are removed, patients are asked to place a topical antibiotic at the removal site and cover this area with gauze, as there may be some leakage from these sites. The drain sites will close by themselves within 48 hours and no further care is necessary.
Most of my patients tell me that although the drains were not as bad as they had imagined, they did not enjoy them. They are sometimes difficult to conceal in clothing and are awkward while showering. This is however a small tradeoff for avoiding a fluid collection (seroma), and allowing the tissues to heal quicker and without infection.