4968 Breast Augmentation and Hematoma: Are Drains Any Useful?

Sunday, May 8, 2011: 3:16 PM
Marcos Sforza, MD, UNIFESO School of Medicine, Birmingham, United Kingdom, Katarina Andjelkov, MD, Private, Birmingham, United Kingdom and Renato Zaccheddu, Private Practice, Birmingham, United Kingdom

Breast augmentation and hematoma: are drains any useful?


Hematoma following a breast augmentation is diagnosed when a sudden enlargement of the breast appears within usually two-three hours (sometimes even more quickly). In such a condition, Breast is typically tense, tender and painful and may also present bruising. The diagnosis is mainly clinical.


Two consecutive groups of patients which constituted 777 subjects were retrospectively analyzed (clinical audit). In the first group (466, Jan 2004-June 2005) drains were used for 12-24 hours. In the second group,No drains were used (311, July 2005-December 2006). The age ranged from 18 to 64, all females, 347 smokers.  All procedures were performed by the same surgeon, under general anaesthesia. Only cohesive silicone textured implants were used. The breast implant pocket was created with a monopolar diathermy forceps minimizing the surgical trauma as advocated by Tebbetts.  The incision was inframammary in 714 cases (92%) and inferior hemiperiareolar in 63 (8%). One hundred and seventy seven implants were placed subglandulary and 600 subpectorarly (dual plane I-III). The  operating time ranged between 20 and 47 minutes. A soft, comfortable bra was used for the subglandular implant immediately after the procedure. When the implant was subpectoral, only an upper pole binder was applied for the first 10-14 days and a soft bra thereafter.


The data were analysed using odds which mainly shows  how many times the probability of developing hematoma is higher than the probability of not developing hematoma. Compared to probability, odds are not constrained as they can take any value between 0 and infinity. For rare outcomes, i.e. P<0.1, odds and probability will be very close. Odds are more practical and in our study have similar interpretations as probability. 2.1% patients from the first group (drains) and 0.6% of the second group were diagnosed with a hematoma. Fisher's exact text did not reveal any significant evidence of the necessity of using drains for the prevention of hematoma (p>0.10). After controlling for smoking and pocket, the risk of developing hematoma is higher with drains than with no drains (p=0.06).

These graphs below illustrate the odds for developing hematoma amongst smokers and non smokers. For group I the risk of hematoma seems to be higher when the patient smokes.

For the purpose of identifying the constituents involved in the development of such complication, we have analysed three underlying factors; smoking, the use of drains and pocket. With p=0.1 smoking and group have significant effect with the effect of smoking having much larger magnitude.

Analysing smoking in both groups revealed that 2.3% of smokers developed hematoma in comparison to only 0.9% of non smokers. Smoking increases the odds of developing hematoma by 174%.

1.1% patients from the first group (drains) developed seroma against 0.6% in the second group. There is no significant evidence of the necessity of using drains for the prevention of seroma (p>0.05) The analysis of the odds ratio as illustrated in the graph signify that smoking also plays a major role in the development of seroma, more significantly than the position of the implants or the use of drains.

 A conservative treatment was never considered once hematoma was clearly apparent. All patients with hematoma underwent a surgical evacuation. A drain was subsequently re-applied on the first group.  The second group was kept without drains even after the hematoma evacuation. Postoperative care was the same as for the primary surgery.


We did not observe any hematoma recurrence; moreover, we did not notice any increased rate of implant infection.  Similarly, the rate of capsular contraction did not increase after a 3-year follow-up. There is not a general consensus as per using drain with a breast augmentation and the relevant medical literature is limited. We do believe that a breast hematoma has to be drained surgically. A conservative treatment is likely to increase the chance of implant infection and capsular contraction. We did not find any significant difference in the infection rate between the two groups. Therefore, in this circumstance, we cannot support the theory that the drain could be a potential entry port for microorganisms causing infection.   As we all intuitively know, smoking was proved to be conducive to the development of postoperative complications such as hematoma and seroma. Our hematoma rate after breast enlargement has significantly decreased since we have stopped using drains. We think that the reason behind it might be threefold:

-The preconceived effectiveness of drains could lead the surgeon to disparage a more careful hemostasis due to the widely held assumption of "false security" given by the drains presence.

-The lack of possible internal tissue trauma secondary to drain displacement or removal.

-Absence of continuous intra-pocket negative pressure, which might possibly slow or impair the local coagulation process.

Based on our experience, we strongly believe that the use of drains in breast augmentation is not only unnecessary but even deleterious.

Back to: Sunday Afternoon
<< Previous Abstract | Next Abstract