Gynecomastia reduction surgery is very common for either young or middle-aged males who have various amounts of breast tissue development. While some forms of gynecomastia are treated by liposuction alone, more than half of them require an open approach through an inferior areolar incision. When doing an open gynecomastia reduction, it is common practice to insert a drain to prevent an after surgery fluid collection.
While the use of a drain out the side of the chest is not usually in place for very long after surgery (a few days up to a week), it is still an annoyance to the patient. Like the use of drains in other procedures like breast reduction and facelifts, the question is often raised as to their true need. It may be tradition to use them but are they really necessary
In the March 2014 issue of the Aesthetic Surgery Journal, an article was published entitled ‘Necessity of Suction Drains in Gynecomastia’. In this paper, the authors looked at their complication rates in gynecomastia reduction surgery when no closed suction drains were used. In 138 consecutive men who had gynecomastia reduction by ultrasonic-assisted liposuction both with and without the pull-through technique. The average of the patients was around 30 years old. The amount of fat removed from each side of the chest was around 350ccs. The pull through was needed in 23 patients. (17%) They had only one hematoma and no seromas. These results lead the authors to conclude that the use of drains is not needed in gynecomastia reduction.
It is important to realize when looking at these study results that less than 20% of the patients treated had an open excision of the gynecomastia tissue, which is the main indication for the use of a drain. Drains are never used in chest liposuction. Thus, this study is not convincing that there is no value whatsoever for drains in gynecomastia surgery. I would be a lot more convinced if all 138 patients in the study had an open pull through technique done.
What this study does demonstrate is that smaller amounts of breast tissue removed through an open areolar approach is probably not needed. But for larger amounts of breast tissue removed, particularly in combination with liposuction in the surrounding chest, a few days of a drain would not hurt.
Dr. Barry Eppley
Indianapolis, Indiana