T he use of surgical drains in plastic surgery is often glossed over or even feared, so in this episode I go over why they're necessary and how to take care of them. Surgical drains work with your body's natural healing process, but they do require some basic care in order to ensure you get the best results.
Tune in while I go over the common concerns, potential complications, and basic care practices so you can feel more confident when planning your next procedure!
Dr. Hall: Welcome to The Trillium Show, where we help you make the changes you want to see in your body, in your mind, and in your life. I'm your host, Dr. Jason Hall.
Dr. Hall: All right, hey, everybody. What the goal of this is, is to talk about something that really gets kind of glossed over in plastic surgery, that is the use of drains in plastic surgery. Now, using drains in plastic surgery is one of the things that most patients fear a little bit, don't like a lot. And to tell you the truth, most surgeons don't like them a lot either.
However, in some procedures, they're really necessary. And the purpose of this is to talk about what a drain is and go over, kind of, when you need them and really how to take care of it because I think a lot of the fear and anxiety about drains is just not knowing how to take care of them. So, we'll go over that today. So, this is a surgical drain, the drain itself is made out of really flexible, thin, silicone rubber, a JP drain is traditionally flat. And the drain itself is connected to a drain bulb, which is also a little rubber thing, and it is where the fluid that the drain is supposed to be getting out is collected.
Drains are used because we don't want fluid collecting in the space that's left behind after we do a surgery. In a lot of plastic surgery, what a patient sees is the incision: they see the facelift incision around the ears; they see the breast incision for breast lift or breast reduction; they see hopefully a very low, you know, symmetric, straight scar from an abdominoplasty. And what you don't see on the inside is all of the tissue planes that needed to be opened up so that we can move things around and create the shapes that we're looking to create with our surgeries. When your body heals—and the analogy I use here is skinning your knee—when your body heals the natural response for your body to try and heal an injury is to produce serous fluid, which has a lot of proteins and healing growth factors and things in them to get your body to heal. If you skinned your knee, you know that kind of weeps and is kind of nasty for a day or two until a scab forms? The same thing happens on the inside of your body.
And I'll use a tummy tuck as an example. So, with tummy tuck surgery, you've got your muscle layer and then you've got the layer of skin and fat that gets lifted up and moved around to remove the excess and tighten that skin layer. There's a lot of empty space underneath that skin when we're done and what happens is that both of those layers produce a small amount of serous fluid trying to heal. If the amount of fluid that is produced by your body is more than your body can absorb—and in some of these larger surgeries it can be—then that fluid has nowhere else to go and just collects underneath your skin, and that prevents your skin from healing like it should. In some cases, this can produce noticeable deformities and is kind of how we diagnose these fluid collections after surgery if we haven't used a drain or we've pulled a drain out before it was ready.
In these surgeries, what we'll do is place one or two or more of these drain tubes underneath your skin that exit either through a smaller incision or through your main incision to help drain that fluid out while your body is recovering and healing. Once it gets to a point where it looks like there is little enough fluid coming through that drain, then we can just slide that drain out of that incision. The drain site heals, almost imperceptibly in most cases, and you're no worse for the wear. And that's really the reason that we need to use drain tubes in plastic surgeries, to prevent that fluid buildup from compromising your result.
One of the nerve-wracking things about drains is how do you take care of these things. They kind of come out of the skin, they're a little bit gross, they're kind of hard to manage, and so I want to go over a couple of tips and tricks on how to manage a drain if you have to deal with one of these things after surgery. I do a lot of facelift surgery and with facelift surgery, you're going to have a drain for a day or so. Loops down around underneath the skin of your neck to keep fluid from building up for a night or two after surgery and again comes out through a small incision behind your ear that is just removed very, very simply at our first postoperative visit, and really is something that most patients don't really even notice. It's a little bit of a pain in the butt but is not a huge deal because it's in for such a short time and you typically have a big dressing that's kind of compressing everything while that drain is in.
For abdominal surgery—and this is where I use drains about half the time at least—is that drain comes out your incision and sits under the abdominal skin to drain that fluid off. Those drains are secured to your skin with a small stitch and are not something that you really need to worry about. Your inner compression garment—the big thing is to keep the drain out of the way when you go to the bathroom when you get in the shower, you want to make sure you're kind of minding where the drain bulb is and the extra tubing for the drain are so that you don't snag that because it can either hurt or you can, if you pull it hard enough, you can pull the drain out. And so, a nifty trick that a patient of mine number of years told me is that what she would do is get a lanyard, one of those nylon webbing lanyards like people get—they give out at meetings with your name badge on it is get one of those nylon lanyards and you can clip the drain bulb to the lanyard and hang that around your neck while you are in the shower and that keeps the tubing up out of your way and keeps the ball out of your way so you can maneuver.
That's especially helpful for patients who have drains from breast surgery. Now, I don't use drains for breast surgery very often, but if you're watching this and are anticipating breast surgery and are going to have drains, that's a neat little trick to help make taking a shower easier. That kind of brings me to another point is that you can shower with drains. You can get the drains wet, you can get the drain site wet.
I say that with a little asterix. If you're a patient who's not one of my patients, and/or you're a patient who has drains with an implant in like a breast reconstruction, ask your surgeon before you get in the shower because some surgeons really do not like patients with drains getting in the water. So, if you're not one of my patients and you are having drains for another reason, check with your surgeon before you get it wet. But for my patients, please shower. Don't go underwater, don't get in the bathtub, don't get in hot tub, jacuzzi, anything like that, with your drain. But you can sit in the shower, let the water run over it; you can stand in the shower, let the water run over those, and get them wet.
Next thing we're going to talk about is some basic drain care. This is what's considered a closed suction drain. So, this part is in your skin, there is a little black dot on the drain. That is typically used to mark the level the drain is in your skin in this area we can cut to whatever length we want, so this is not necessarily how long that drain is. What you're going to want to do is squeeze the drain bulb, push this little plug into the hole; it stays collapsed.
Now, if I let go on my end, me pinching the drain tube is simulating the strain being underneath your skin under suction. So, it's pulling whatever fluid is in there out. If I let go of the suction, you see the bulb fills up, we lose our suction. And if that happens to you at home, that means one of two things: that means either the drain has slid, backed out of your skin—the suture was too loose or you pulled on it—and so that the first of these little teeny holes in the drain themselves have come out from underneath your skin and it's letting air in, or the tubing itself is damaged. Along here there's a little hole that's in the tubing, or one of the connections is loose.
And so, those are things to check. But if your drain is losing suction, call the office and we can either—we'll either see you or we can kind of talk you through some troubleshooting. Let's talk about how you need to take care of this. So, the biggest thing that I want patients to do is something called milking your drain. So, how this works is every eight hours or so, what you want to do is you want to grab and pinch the part of the drain tube that is closest to your skin, with the bulb still on suction.
So, plunger is here, the bulb is compressed, what you want to do is pinch here and with your other hand, you want to pull and squeeze, to flatten that tube out. And like I'm pulling pretty hard here. These tubes are fairly resilient so don't worry about breaking them. But you pinch, pull, you're essentially squeezing all the fluid in the tube back towards the drain. And that's to get in if there's any protein material, if there's any little blood clots or things in that drain tube, it cleans them out so that that drain can continue to function well and do its job while it's there. The better it works, the quicker that we can get it out.
For milking the drain, you again want to do this about every eight hours or so right before you write down how much is coming out of your drain. This is very important. These drains are graduated: 100 milliliters, 75, 50, and 25 milliliters. You want to read these things with the bulb on unattached. That gives you a better estimate of volume. If it's collapsed, it doesn't really give you a good estimate of how much volume is in there.
So, pop the top, read how much is in there. If you've got a little ounce cup at home, you can empty that, squeeze the bulb, empty that out into a little cup, you can measure it. Write down that number on your drain log so that we can see it, and then you squeeze this and push the plug back in it to reseal that drain and keep it on suction. Again, it's really important to write down how much is coming out of those drains because that's how we know when those drains are ready to come out.
One question that often comes up is with patients who have had drains for a couple of days or a week, especially patients whose drain is persistent and producing a lot of fluid—either because that's just how your body is built, or we've done a lot of liposuction in conjunction with other body surgery—that the area around the drain tends to get a little bit irritated and pink, especially around the sutures, and you may have a little bit of fluid that leaks out of that. It's very rare for these things to become infected. That reaction is just a reaction to that drain that kind of moves a little bit and slides and irritates the skin. Best thing to do is just snap a picture of that, give the office a call and we're happy to coach you through it. If it looks like there's a problem, we certainly have you come in to check it out. But usually, it's just a little bit of irritation from the drain. I hope you found this interesting, helpful, informative. If there are any questions, especially drain-related questions, you can shoot us an email.
Dr. Hall: Thanks for listening to The Trillium Show. You can keep up with the latest on the podcast at jhallmd.com. Be sure to follow us on Spotify, Apple Podcasts, or wherever you listen to podcasts. If you want to connect with us on social media, you can find us at @jhallmd on Instagram and Twitter and @DrHallPlasticSurgery on Facebook. Remember, be the change you wish to see in the world.