Susan's Place Transgender Resources

I had mentioned in another thread that I had my surgery consult last Thursday. During the consult he had mentioned to me I had the option of not having jp drains or having them. He said he has done a few top surgeries without them and it made no difference. He stated one might get a small seroma but the body absorbs the fluid.

I told him I wanted the drains at the time, because I have seen a few guys that have had seromas and it left almost like a little pocket where the fluid had sat. He said if that's my preference that's fine. What would you guys have done if you were presented with the same option?

I just had my surgery on Wednesday and these drains are a pita. I have soreness and redness where the drains are and they are irritating! I'm hoping to call my doc to get them out early. I hope to see more responses from those without the drains, but I hate them and given the option, I'd go without them!

Quote from: Darrin Scott on March 16, 2014, 03:02:18 PM
I hate them and given the option, I'd go without them!

I've had jp drains with kidney surgeries (I had one for 8 weeks when they severed my ureter once) so I'm familiar with them. However, having one on your side is a lot different than having two up under your arms I'm sure. I just worry about the possibility that it might alter the appearance of my chest in the long run if I let fluid pocket there and wait to be absorbed.

CRAP!  I wrote a long post, but is disappered!

In a nut shell I said that I hadn't heard of Lawton before this board (but this is really the only trans* social web site I am on).  I am wondering if he has done a lot of these surgeries.  I was suggesting that if he has not, I would go with what the majority of busy top surgeons do.  Garramone uses drains, I think that Medalie does too (I think he does a good number of surgeries).  I wonder if Brownstein used drains?  That is how I would make my decision, again, if my surgeon doesn't specialize in this surgery.  I think I would also push to understand why he doesn't have a preference, also.

For me, short term discomfort is meaningless when it comes to outcome.  Do you know how often it is a seroma occurs without drains?  There are probably no academic studies on this. 

Of course, I am 5 months out and still have very small "puff" of swelling under one arm from the drain.  I have never heard of this not going away though.

Hard decision.  Good luck.

I had 3 drains. 2 to start with then needed another in right after a seroma build up. Personally I wouldn't advise going without. My left side is absolurely fine with full range of motion and looking good. Up until a few weeks ago my right side looked bad, nipple looked stretched and the scars are wider there. It's looking much, much better there but it's still hard and tight. Still don't have full range of motion with my arm, and it's bigger than the left. Harder tissue at scar that could take up to a year to resolve. I had my surgery the end of last year!

Never had a problem with drains. Too numb to notice anything with them anyway. The 3rd one I felt a little more because it was weeks later but I was at Taekwon-do classes with that one in. It was nothing! And I was able to sleep on my side with that one. Lol.

Some have more issues than most. I got unlucky thanks to douche yanking my arm on the bus but seeing what a seroma can do and how much it can set you back in healing, is 5 days or so of very little discomfort that bad in the grand scheme of things?

Just my two cents.

I had drains for just a few days and wasn't going anywhere that soon after surgery anyway. I would not have wanted to skip them because I understand that fluid absorption takes quite a while; in the meantime, you can't be sure whether the swelling is fluid or something more problematic.

People's experiences with the removal process seems to vary widely. I have a low pain threshold and was expecting the process to really hurt. It didn't. I felt some twinges but mostly just...weirdness. For me, it was no big deal.

How long are you expecting to have the drains?

Well it is a serious PITA while healing, but in the grand scheme of things, it doesn't seem to make much difference. I also have swelling under one arm, but funny thing, this was NOT the drain I had the most discomfort and pain with. Yes, I have never heard of it not going down eventually.

Hi Jack, missed your charming self for the last few weeks. :)

--Jay

Quote from: chipper on March 16, 2014, 06:30:04 PM
I ended up having my drains in for 13 days due to lack of decrease in fluid production. I produced a fair amount of fluid and I can't imagine all that fluid just hanging in my chest. I understand the body absorbs some... but how much? Despite the annoyance and discomfort, I'd do the drains in a heartbeat, just for the piece of mind. Plus, undergoing another surgical procedure to remove fluid might be just as uncomfortable as the drains themselves. That's my take on Jackson Pratt.

I had the site drained with syringes twice before the 3rd drain was put in. The surgical procedure (drain in) was fine. Didn't feel a thing! It was a long annoyance though with appointment for ultrasound and then drain. However, removing with syringe, ow!!! I have a high pain tolerance and I'm one of those guys who'll hide it even if it does hurt. For most of it, it was fine but I remember one particular push of the needle that nearly had me in tears! And that was despite the numbing! It was also easier to do with me standing which is difficult, especially when you see just how much brown, bloody horrible stuff is coming out of your chest! Just over 650mls in one draining! That was a record for my surgeon! Surgical part is fine but that comes after syringe removal.

And hey again Jay! Been super busy lately. Was in contract negotiations for work with different employers, as well as prepping for a Taekwon-do sparring competition in May, grading in July, World Cup competition in Jamaica in August and getting that booked...life has been hectic, but at least all in a good way :-).

I'd get them but with the stipulation that if you are not draining much then the surgeon should take them out and not wait a week.

Quote from: Arch on March 16, 2014, 06:28:27 PM
How long are you expecting to have the drains?

He said most who got them have them 4 to 5 days. He's going to have me come back in the day after surgery for follow up. He likes to check on guys the next morning so I'll get to see my chest for the first time then and he'll look at the drains. I might see if he'll just let my wife pull them a few days after that instead of driving back down (she's an EMT so I feel confident she can snip a stitch and yank a tube).

I didn't get an option, but had I have had one - I would have still opted to have them in.

I wouldn't want to chance any issues with fluid squishing around freely in the chest.  I can't imagine that your skin is going to settle out quickly as it's still separated from the underlying tissue by loads of fluid.  IMHO not having drains would just delay healing, but some guys obviously have went without them and had no issues. *shrug*

I would use drains for safety if I were you.

I'm biased though, had so much fluid buildup that the drains weren't nearly enough.

The drain tubes can pull on your skin and change your scar pattern, but having pockets of liquid get too big can cause more than just cosmetic problems. I agree with the mentioned detail that you can negotiate with your surgeon as to how long the drains stay in if you get them.

After I had my drains taken out I had to have fluid aspirated with a needle and syringe a few times, and I have a tiny bright red scar at one of the sites. I'm not sure why it happened, but it stands out. For comparison, I can't even find the marks from the drain placement.

Some of this might depend on how confident you are. When there's fluid, you feel it very much, and the drains aren't fun but for some people are less icky than waiting for the sloshing to be absorbed.

Felix, you make a drainless procedure sound like so much fun!!

You could always be one of those guys with a LOT of fluid (like a friend of mine was). I had so little probably could have done this. You don't really know this though, I suppose. But whether to have drains or not wasn't a factor in choosing a surgeon, for me.

--Jay

Of course, hindsight is always 20/20 and it turned out I didn't need the drains at all, there's was nothing right from day 1. So having that knowledge I can say I would have preferred not to have them in given the choice. I can't say with absolute certainty that I would have had the same response going in because like others have mentioned, sometimes it's better to have them there.

If I had the option, I'd go with the drains as I would feel more comfortable having them in instead of allowing my body to naturally drain them.

Odd that almost everyone here is almost completely pro-drains, while Yelland in the UK (one of the busiest and IMO better) top surgeons never uses them.  I'm wondering if there's a bit of a cultural thing in it too like there is with antibiotics, we'd never get given antibiotics after surgery and before getting an infection.  I think most people here would be shocked by that.

Quote from: lxndr on March 17, 2014, 04:19:18 PM
Odd that almost everyone here is almost completely pro-drains, while Yelland in the UK (one of the busiest and IMO better) top surgeons never uses them.  I'm wondering if there's a bit of a cultural thing in it too like there is with antibiotics, we'd never get given antibiotics after surgery and before getting an infection.  I think most people here would be shocked by that.

You're probably 100% correct. The only surgeon I have heard on in the States that doesn't use drains is Dr. Raphael and he just began doing surgeries without them.

As far as the antibiotics, I think the doctors here believe in the old adage, "an ounce of prevention is worth a pound of cure".

Quote from: Simon on March 17, 2014, 06:37:57 PM
You're probably 100% correct. The only surgeon I have heard on in the States that doesn't use drains is Dr. Raphael and he just began doing surgeries without them.

As far as the antibiotics, I think the doctors here believe in the old adage, "an ounce of prevention is worth a pound of cure".

FB's and Nathan's surgeon didn't do drains.  I think he has only done a handful of these surgeries, though.

To circle back to what I was saying Simon, is if it is that rare for surgeons not to use drains, than I would say yes to the drains.

Quote from: lxndr on March 17, 2014, 04:19:18 PM
Odd that almost everyone here is almost completely pro-drains, while Yelland in the UK (one of the busiest and IMO better) top surgeons never uses them.  I'm wondering if there's a bit of a cultural thing in it too like there is with antibiotics, we'd never get given antibiotics after surgery and before getting an infection.  I think most people here would be shocked by that.

Yeah I know about Mr. Yelland. One of my good friends went to him. I am not really pro, just that it is commonly done and I wouldn't make a decision based on it. My friend got a hematoma, but it could have just been a coincidence, after all complications occur at a rate of 5% or something and even the best surgeons get them.

--Jay

I definitely would go with drains.  They really weren't that big of a pain in the ass, and with all the vicoden its really not a bother.  I guess just seems a safer bet to me?  but I'm no medical expert

I agree though about the antibiotics.  Why do doctors love to give them out when there is no problem?!  We're creating super bacteria!!! I definitely did not take antibiotics after surgery.  (In fact I typically toss the prescription in the trash unfilled in almost any situation) 

I'm in Australia, and I've not heard of anyone here NOT using drains.  I was given "prophylactic" antibiotics for only one day - that being said, Australia doesn't even have the antibiotic culture that America does - so considering I'm almost never given antibiotics here unless I'm seriously unwell, I took them as I figured they had a reason for wanting me to.

I put down my deposit and secured my surgery day today! Surgery is July 31st at 7am, I am sooo excited even if it seems a lifetime away at this point.

My pre op appointment is July 21st. I'm going to tell him I want drains for certain then. I think it would put my mind at ease. I'd rather deal with a little annoyance for a week then possibly effect my long term results.

Jay, I think I possibly know who you're talking about with the haematoma, I think I remember him saying that Yelland told him that it happens in 1% of all operations, and his chest still looks amazing.  From the pictures I've seen you'd have never have guessed that there'd ever been any complications.

Doctors here hate giving out antibiotics unless there's a real reason to (in which case you should definitely take them) because the bacteria becomes more resistant to them.  We've had a couple of instances of really nasty MRSA here, which is why we're generally against them.  Prophylactic literally just means that they're given as prevention rather than cure.

Quote from: lxndr on March 18, 2014, 05:04:22 PM
Jay, I think I possibly know who you're talking about with the haematoma, I think I remember him saying that Yelland told him that it happens in 1% of all operations, and his chest still looks amazing.  From the pictures I've seen you'd have never have guessed that there'd ever been any complications.

Doctors here hate giving out antibiotics unless there's a real reason to (in which case you should definitely take them) because the bacteria becomes more resistant to them.  We've had a couple of instances of really nasty MRSA here, which is why we're generally against them.  Prophylactic literally just means that they're given as prevention rather than cure.

Well I think that complication rate anyway is 1% (I am pretty sure you do know who I am talking about-- pretty well known older trans guy). I don't think you can make a case from one individual. Usually they don't end up making a chest look worse. I have only seen once where it absolutely did.

It's very very common to give prophylactic antibiotics for ANY kind of surgery here (including dental). But I don't go to a doctor, myself, who is very big on prescribing antibiotics, but many doctors here are more big on them.


--Jay

I think the U.S. is finally starting to get the idea that we have been over prescribing anti-biotics.  It seems like docs are not handing them out as easily as in the past. 

However, yes I took them after surgery (Garramone), and since I very rarely take an antibiotic, I was fine with it.

I didn't have drains. No complcations and the recovery was relatively painless.
I can't find the article so I don't want to say it as fact, but I believe it's been proven that the drains don't make much of a difference in aiding recovery.

Quote from: timbuck2 on March 19, 2014, 01:26:17 AM
I didn't have drains. No complcations and the recovery was relatively painless.
I can't find the article so I don't want to say it as fact, but I believe it's been proven that the drains don't make much of a difference in aiding recovery.

timbuck2, can you please remind us who your surgeon was?

Quote from: Brett on March 19, 2014, 08:05:21 PM
timbuck2, can you please remind us who your surgeon was?

Ah, sorry! Curtis Crane in San Francisco, CA.

Quote from: timbuck2 on March 20, 2014, 01:20:27 AM
Ah, sorry! Curtis Crane in San Francisco, CA.

No worries, it was my fault.  You have told us before.  I think it is helpful though, that people know who doesn't use drains if others are looking.  Do you happen to know if Brownstein used drains?  I know that he trained Crane. 

Did you have much liquid floating around in there?  I know FB and Nathan said their's felt kind of weird.

Quote from: timbuck2 on March 20, 2014, 01:20:27 AM
Ah, sorry! Curtis Crane in San Francisco, CA.

That's interesting, I didn't know Dr Crane did them without drains (I know Brownstein used to use them).

I know Dr Raphael and stopped using drains but he uses a technique where he "quilts" the skin to the muscle tissue so there is really no room for fluid to pool.

I'm still on the fence. I have a good while to think about it (pre op is July 21st) so between now and then I think I'm going to research to see who didn't have drains and what results they had.

I know Brownstein used them but I'm under the impression that Crane has only recently started doing them without drains. He may have started soon after he took over the practice, I can't quite remember.

For the first few days after the big reveal they did feel kind of weird...I'm not sure if I could say it was a feeling of liquid but it definitely was strange. If there was any extra fluid it was certainly reabsorbed by the body

And Simon, if you'd be interested in pictures of my chest for for comparison purposes I'd be happy to message them to you :)

Quote from: Brett on March 17, 2014, 07:44:12 PM
FB's and Nathan's surgeon didn't do drains.  I think he has only done a handful of these surgeries, though.

To circle back to what I was saying Simon, is if it is that rare for surgeons not to use drains, than I would say yes to the drains.

You rang? Yeah, our surgeon doesnt use drains, he said theyre uncomfortable and not really needed. SOMETIMES seraomas can pop up but those are easily drained and can happen even WITH drains.

I also found out from a nurse that my surgeon, who is AMAZING in every way, has been doing gender reassignment surgeries since the 80s-He even used to do Phallo! But he stopped, knowing him its because he couldnt give patients a working penis, and that bothered him. But i cant say for sure.

Anyways, neither me nor my boyfriend had drains and everything is fine. no fluid build up and no uncomfy drains. it is a bit weird to feel fluid moving through your chest though. Nate HATED it.

I would say, go without them. The worst case scenario, you have a little build up that can be removed easily, and the little loose 'pocket' that people sometimes get tightens with time. No dog ears, either!

By the way, having drains or not has nothing to do with dog ears. Just thought that worth mentioning. Skin will tighten to where it's going to over time regardless of draining or even haemotomas or seromas as complications. I had one of the worst cases of fluid build up and don't have dog ears. The biggest factors with regards to whether or not you get dog ears are how good your surgeon is and your physique. If you're at a healthy weight with some pec development, assuming you have a good surgeon you have far less chance of dog ears than someone overweight with a less talented surgeon. Of course there will be lucky or unlucky cases; it's more a general norm.

Quote from: Jack_M on March 23, 2014, 12:28:10 AM
By the way, having drains or not has nothing to do with dog ears. Just thought that worth mentioning. Skin will tighten to where it's going to over time regardless of draining or even haemotomas or seromas as complications. I had one of the worst cases of fluid build up and don't have dog ears. The biggest factors with regards to whether or not you get dog ears are how good your surgeon is and your physique. If you're at a healthy weight with some pec development, assuming you have a good surgeon you have far less chance of dog ears than someone overweight with a less talented surgeon. Of course there will be lucky or unlucky cases; it's more a general norm.

It seems to me like there are either more skilled surgeons coming into the mix or surgeons are getting better.  I don't hear of many guys getting dog ears anymore. 

To follow up with what Jay said about heavier guys with less talented surgeons getting dog ears, the other thing is that sometimes it is back fat that the person is complaining about and not dog ears.  That is additional surgery.

On the dog ear subject, I'm not worried about it. My surgeon fixes those for free under local anesthetic if those happen.

I didn't have drains for my surgery and didn't have any complications. My surgeons afaik never uses drains, he told me that the way he performs the surgery does a lot to reduce fluid build up and so drains aren't necessary. He's been performing top surgery since the 80s, and apparently performs 4-5 per week still. Personally, I'd say don't do the drains if your surgeon offers the option. A friend had bad complications with his chest (did his with another local surgeon), but they still managed to drain his chest as needed without them, and now he's fine.

Quote from: Berserk on March 26, 2014, 05:25:22 PM
I didn't have drains for my surgery and didn't have any complications. My surgeons afaik never uses drains, he told me that the way he performs the surgery does a lot to reduce fluid build up and so drains aren't necessary. He's been performing top surgery since the 80s, and apparently performs 4-5 per week still. Personally, I'd say don't do the drains if your surgeon offers the option. A friend had bad complications with his chest (did his with another local surgeon), but they still managed to drain his chest as needed without them, and now he's fine.

Hi, Berseck.  Can I asked who your surgeon was?

Quote from: Brett on March 26, 2014, 11:28:51 PM
Hi, Berseck.  Can I asked who your surgeon was?

Dr. McLean at the McLean Clinic in Mississauga, Ontario. Both he and the staff were really amazing and I'd definitely recommend him. Total was 7,345 including taxes (Canadian Dollars) which also included revisions.

Quote from: Berserk on March 27, 2014, 12:18:33 PM
Dr. McLean at the McLean Clinic in Mississauga, Ontario. Both he and the staff were really amazing and I'd definitely recommend him. Total was 7,345 including taxes (Canadian Dollars) which also included revisions.

Great.  Thanks for your response.

Even though this post is years old.  A lot of surgeries are doing drain free methods.  My top surgery is scheduled with Dr. Reed in Austin and he does about 3-4 top surgeries a week and uses a drain free method.  I've been doing a lot a research on "To drain or not to drain" and the data is inconclusive in regards to drains preventing infection and build more than not draining does.  It is because of the lack of proof that drains are more beneficial a lot of surgeons are opting not to use them or to give guys a choice.  I was a little nervous about not having drains because of how common they are but like most surgeons, Dr. Reed will do additional work for any complications that may arise.  I'm an overall healthy guy.  I've never had the flu and don't really get sick so I'm not too worried about going drain-less.