Closed-Suction Drains After Subcutaneous Mastectomy for Gynecomastia: Do They Reduce Complications? A Different Approach.

Introduction: We read the manuscript entitled "Closed-suction drains after subcutaneous mastectomy for gynecomastia: do they reduce complications? » published by Chao et al. (Aesthetic Plast Surg, 2017. https://doi.org/10.1007/s00266-017-0959-z ). They have concluded that drains may reduce rates of seromas requiring needle aspiration after surgical treatment, but also that there are several adverse effects of drains: patients' discomfort, anxiety, cost and additional clinic visits. They also recalled several limitations: (1) bias in terms of surgeon decision to place a drain, (2) nuances in technique. Here we want to discuss our different technique of drainage. To prevent all the disadvantages, we have chosen to replace closed-suction drains with silicone blades and a wide scar opening at the level of the periareolar scar.

Method: We carried out a retrospective study in our department in 2016.

Results: This series consisted of 83 patients (153 breasts) aged 26.7 years of age (15-67), with an average BMI of 28.6 (19.5-39). All were followed during the 12 months postoperatively. We considered here only grade 1-2a gynecomastia with palpable fibrous glandular tissue. The surgical procedure consisted of initial liposuction, then open surgical excision via the periareolar approach. We did not notice any seroma or collection requiring intervention. However, 4 patients (4/153; 2.6%) had hematomas requiring intervention the day after surgery.

Conclusion: Our technique presents a lot of advantages, reduced length of stay in the hospital, costs from drain site care and clinic visits, patients' discomfort, and antibiotic prescriptions.

Level Of Evidence V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .