To Drain or not to Drain, That is the question.

[Simon]

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?

[Darrin Scott]

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!

[Simon]

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.

[Bimmer Guy]

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.

[Jack_M]

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.

[Arch]

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?

[aleon515]

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

[Jack_M]

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 :-).

[Alexthecat]

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.

[Simon]

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).

[Kreuzfidel]

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*

[Felix]

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.

[Arch]

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

[aleon515]

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

[Jeatyn]

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.

[King Malachite]

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.

[AdamMLP]

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.

[Simon]

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".

[Bimmer Guy]

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.

[aleon515]

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