San Jose, CA-For true gynecomastia, the removal of fat and breast tissue from the male chest will leave a large area of open or “dead space”. The resulting pocket of space is an area that fluids can collect. The fluids that collect are referred to as a seroma and are yellow body fluids. If the collection of fluids is blood, then it would be referred to as a hematoma.
If drains are not put into place after surgery and fluid started to collect, it would need to be removed by needle aspiration. Removing fluid by needle aspiration is not difficult to do, but it is very inconvenient for the patient as it may need to be done every 4 or 5 days until the cavity has collapsed and it may prolong the healing time. To avoid this issue I always use drains unless the gynecomastia patient has had the “light pull-through procedure”.
With the drains in place, any fluid that tends to collect will be removed by squeezing a bulb that is connected by a tube from the cavity and is attached to the outside of the vest. In addition to removing fluid, the suction of the bulb will create a negative pressure that encourages the cavity to close down. After surgery, the patient is placed in a compression vest which fits snugly but not too tight. With both drains and vest, my seroma rate is almost zero. However, there is a small scar from the drain incision that has caused concern for some patients. It can be more obvious than the resulting scar from the gynecomastia surgery that is from the glandular excision around the areola. In listening to my patients, I now have an instrument I use to make the small incision high up in the armpit and towards the back. This has worked out very well and patients have a hard time finding the drain incision.
The drains will remain in place until I determine it is safe to remove them, this is usually at
the first post-operative visit 3 to 4 days after surgery. The fluid that is collecting into the bulb gives me a lot of information and allows me to know what is going on inside, by the speed it is coming out, the consistency, and color. Once the drains are removed, showering is allowed; in the meantime the patient may only have sponge baths.
Due to many comments from patients that the compression vests were bulky and somewhat uncomfortable, I designed my own custom vests. My vests have special pockets for the drain bulbs which can be removed after the drains are taken out. Then there is a thinner vest #2 that men graduate to, it is a cotton T-shirt base layer with a thin layer of compression over only the chest region. Much more comfortable than previous styles and thin enough that even men who wear dress shirts daily do not complain about them showing.
My male breast reduction patients are to wear the compression vest 24/7 for six weeks. It is only to be removed when showering. It is a good idea to have 2 vests so that while laundering one the other can be worn. The vest should be washed on the gentle cycle and line dried. If time is an issue, the vest can be put in the dryer with a couple of towels on the cool air setting.
I treat many patients from out of town, and having no complications post-operatively is a priority for me.