September 29, 2022

PODCAST: Why I Rarely Use Drains [Bonus]

A quick explanation with the scientific basis for why Dr. Whitfield no longer uses drains, outside of certain circumstances. He shares his alternatives for preventing and avoiding post-op inflammation.

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Transcript

Speaker 1 (00:03):
Welcome to The Holistic and Scientific Podcast, with board certified plastic surgeon, Dr. Robert Whitfield, Austin’s natural choice for plastic surgery, and the expert in smart laser and energy treatments.

Candice Barley (00:21):
Recovery was a little rough. I got an infection from the drains.

Dr. Robert Whitfield (00:25):
All right, we’re going to have to talk about the drains.

Candice Barley (00:28):
Yeah. And that was one thing, which when you don’t have all of the information, I was like, oh, and I know that the doctor has to do drains. If they don’t do drains, then there’s something wrong. You got to do drains. Well, I got drains. I had them for three days. Everything had been going fine. On the third day, went into the office, had them removed by the surgeon, and within 48 hours, I had a fever. The area was red and very obviously infected.

Dr. Robert Whitfield (01:00):
Yeah. So just so all the listeners understand, all of the studies suggest that the use of a drain ultimately is associated with a higher rate of infection. And so let’s just talk about why we would use drains in the first place. And I’ve used drains for breast cancer reconstruction, for tummy tucks, for breast implant removals, so I will just give you my two cents on why. You use them initially, as a surgeon, because you don’t want to leave a space that’s opened to fill just with fluid and develop what’s called a seroma cavity, because then you have this fluid build up. And so I would argue it this way. I’ve gone to not using drains except for in really specific instances. So if I have a extra capsular rupture, which means your implant capsule, your scar, has been compromised by the rupture, that usually means the gel or filler of the silicon device is now extravasated or leaked through your capsules in your breast tissue.

Dr. Robert Whitfield (02:06):
That is a very unfortunate situation that I don’t find very often anymore, but in that situation, I am very apt to use a drain, because I cannot get the pocket devoid or cleared of materials easily. Because breast tissue is not something you can just magically clean and oh, it’s fine, and be done with it. Now, the other time I’ve used the drain, now drains don’t stop infections. They don’t stop bleeding. They don’t stop you from getting a seroma, just so that everybody’s clear. We hope that they do, but that’s not ever been proven, really. So if you have a particularly problematic case and there’s a propensity of bleeding for reasons beyond your control, maybe it’s difficult to control their blood pressure, maybe they just are somebody who has bled more during the case, maybe they’re more inflamed. You never know the given situation, so I don’t want to be throwing blanket statements here, so I will use them in those cases.

Dr. Robert Whitfield (03:08):
But most of what I do is create an environment where I don’t have to, by lifting up the fold so that the fold will rise, disrupting that lower area so that internally, it will drain. And that may sound like heresy, but I don’t use drains in tummy tucks either. Haven’t for a long time. So that you can do with a progressive suturing technique, and you can also do the same thing I just described, which is undermining and basically internally draining it, which is your body’s going to, if you will, absorb the fluid and then eliminate the fluid, provided several things are in order, right? So I put patients on a particular diet that’s higher in protein. I try to make sure the foods they eat don’t create more inflammation or more edema or fluid. And we use supplements and we use anti-inflammatory and we use ice.

Dr. Robert Whitfield (04:03):
I mean, we’re doing all these things in conjunction with compression to help mitigate fluid production. If you have a multimodal approach, you’ll do better. And some thin people, tiny little BMI patient, will produce a lot of fluid. And you’ll be like, oh my gosh, how can this tiny person produce all this fluid? Well, if they don’t compress, if they don’t use ice, if they don’t use their anti-inflammatories, if they’re not following the diet, they don’t have enough protein in their diet, I mean, it’s pretty predictable who will do that. So as much as I can do to help, I need a patient who’s really switched on to help themselves.

Candice Barley (04:45):
Definitely have to take responsibility. But it’s so incredible to me that you offer all of these protocols and even just saying, hey, if you up your protein and you reduce inflammatory foods, you’re going to have a better recovery. So I had to research and try to figure all that stuff out on my own.

Speaker 1 (05:09):
Dr. Robert Whitfield is a board-certified plastic surgeon located in Austin, Texas, near 360 and Walsh Tarlton in West Lake. To learn more, go to drrobertwhitfield.com, or follow Dr. Rob on Instagram @DrRobertWhitfield. Links to learn more about Dr. Rob’s smart procedures and anything else mentioned on today’s show are available in the show notes. The Holistic and Scientific Podcast is a production of The Axis.

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