Drains

Drains are used in all top surgery procedures, regardless of the scar placement or treatment of the nipple areola complex. Drains are useful in preventing seroma (fluid buildup) underneath the skin, because after top surgery there is a theoretical space left behind that carries a risk of building up fluid. Fluid can cause problems after surgery including infection, pressure build upon the incision, wounds or opening up of the incision, and poor scarring.

In addition to using drains, you can help yourself prevent fluid collections by controlling your activity level after surgery. You should NOT be bed bound after surgery because you also want to avoid blood clots, but you should be walking frequently at a leisurely pace. You should avoid activities that could raise your heart rate and blood pressure.

The downsides to using drains are minimal. They are temporarily annoying, and you have to take care of them and empty them while they are in place. They are almost always removed at the first postoperative visit after top surgery. At the time of removal they should ideally be putting out less than 20-30 cc per day for two days. They leave behind a small (1 cm) scar on either side of the chest that is located laterally under the armpit.

The best way to care for your drains is to empty them once or twice a day or anytime the drain fills up halfway, and to strip them daily which involves a pinch and pull technique where you pinch the tubing with two sets of fingers starting at the base of the drain and use one set of fingers to pull the fluid out, while maintaining that negative pressure on the tubing.

You can learn more about top surgery and drain care on Dr. Chandler’s YouTube video.