First, the drain is very important to prevent the accumulation of fluid in this detached region. Many times the abdomen is big, the detachment area is bigger, so that we can reposition the abdomen musculature, then there is a detachment of the thorax bone, down to the pubis bone, and, this displacement causes an empty area there, where the whole empty area of the body, or empty space, is filled with liquid, there is no air left there, so we do not want this liquid to accumulate, and the drain is actually not to remove all the liquid. Because the liquid is being produced all the time and reabsorbed, but soon after the surgery, it produces more than the absorption capacity, and then, in these cases, liquid accumulates, and that is the reason why the drain exists, to remove this excess, because it does not stay still, it stays alive like the whole body, it is circulating through the body. The difference is that in these cases, where there is a drain, a little bit, an excess of this liquid ends up coming out through the drain, getting accumulated in this reservoir, so this is the reason why doctors use a drain. Can a drain be used in liposuction, mammoplasty or other aesthetic surgeries, besides abdominoplasty? Of course, the most common is to use it in abdominoplasty. If we do those subcutaneous stitches, those baroudi stitches, we don’t need to use the drain. We do the Baroudi stitches in all our patients, and this is a very good thing, because it really reduces the amount of liquid in the empty space, it reduces the amount of accumulated liquid, but we still make sure to use the drain in everyone, because when liquid gathers, it is very uncomfortable, It is very bad for the patient to have to be pulsating and taking that liquid out every week, and this ends up leaving a lot more swelling, forming a capsule, with an increased volume in that region, and can bring fibrosis, bringing a series of complications, the accumulation of this liquid, which is the seroma.

How does the drain work?

The drain is a rigid silicone tube that stays in the subcutaneous tissue, between the muscle cap and the fat, in the part that we take off to do the plicature, repositioning the muscles. Then, we put this hose or silicon wire inside, it has a series of little holes in the drain’s body and then, the liquid goes inside it to meet this part that is a connection and, from this connection, it goes to a reservoir; This reservoir needs to always stay, let’s say 24 hours a day, with vacuum, sucked in, because if it is in this position, it is because it is not doing the vacuuming and then, this doesn’t help us, only to really interest us in the functioning of the reservoir, when it is in this position, it needs to be in this position 24 hours a day. Ah, but when do we take the liquid out? We remove the valve from the reservoir, pour the liquid in a sink of running water and then redo the vacuuming in this reservoir and this way it stays with the vacuum like this, it keeps sucking the liquid, and thus the liquid does not accumulate .But there is no need to wash this reservoir from the inside. Some clots remain, and they will naturally be washed by the liquid that is coming out.

When do we know when to remove the drain?

It depends on each doctor and the technique used, for example, when these subcutaneous stitches are made, the drain time is shorter, we remove the drain earlier. However, with those very large abdomens, with overweight patients or even patients who are skinny, but who have lost 70 kilos, after bariatric surgery, these patients need to stay longer with the drain, and this makes us leave the drain longer, around two weeks

How do you know the right time to take the drain?

When there is less than 50 ml in 24 hours inside this reservoir, in this marking here with the number of mL, i.e., it was 70ml, it went to 50ml, 40ml, 30ml, and then it’s time to remove the drain, i.e., there is less than 50 ml collected in 24 hours. So, it is important once a day, at about the same time, to drain the liquid and measure how many ml are in this reservoir, and this is very important for the management, even for the doctor to know, look, I can remove the drain, because all patients want to remove the drain in two days of surgery, but still, sometimes there is a very high amount of drainage, With 200 ml, 300 ml, sometimes associated to a liposuction, the volume is even higher than that, because there is a very large detached area, needing time for the body to recover, heal, replace these areas and then, the time will come when it will be less than 50 ml and, thus, we can remove the drain, which is usually around two weeks after the surgery.