Gynecomastia Surgery and the Use of Drains

Many San Francisco gynecomastia patients ask if drains are really necessary. My answer to this is that it is up to the surgeon, each plastic surgeon determines what they feel is best for their male breast reduction patients. I drain!
For the average gynecomastia breast patient I perform an aggressive and wide exposure approach, thereby creating a large area of “open space� or “dead space�. Fluid loves to ooze into this large pocket of “raw space� and by placing a drain in this area, it will collapse the space, evacuate the fluid and the cavity will have negative pressure which encourages it to close down. I also have my patients wear a compression vest for 6 weeks creating the perfect healing environment.
Early in my career I let the complexity of a case determine if I used drains. More than 10% of the time fluid would accumulate inside the “dead space�. This fluid is called a seroma, not blood but yellow body fluid. So every 4 to 5 days it would require needle aspiration, which is easy to do but inconvenient to the patient. This would continue until the cavity collapsed but can prolong the healing. All will work out fine as long as the complication is handled properly in this manner.
After twenty years of experience, I now drain all cases…let me explain further.
Being able to observe what is coming out of the drain can give me some very important information as to what is going on inside! By seeing the consistency of the fluid, the thickness and the speed that it is coming out alerts me and my staff to determine:
• Do we need to observe him longer in the recovery room?
• Possible blood accumulation which necessitates removing the vest to check for swelling
• Or best yet, the fluid is thin, which means all is normal!
My seroma rate is now near zero however there are tradeoffs, the incision from the liposuction or drain site leaves a tiny scar which causes concern for many of my male breast reduction patients. It can be more noticeable than the incision around the areola, which by the way is almost invisible. But I listen to my patients and their concerns are mine and I now have an instrument so that I can take the incision high up in the armpit and toward the back. This makes for a win win situation, patients now have a hard time finding the scar and the drains have become a non-issue.
Many of my gynecomastia patients come from out of town; I need for them to heal without any complications, so that they can return home as soon as possible.