[Should surgeons keep performing drainage after breast reduction?] / Faut-il encore drainer les réductions mammaires ?

OBJECTIVE: Despite the absence of "evidence-based medicine", the use of closed suction drainage in breast surgery is currently the standard practice. Its goal is to minimize the amount of fluid at the operation site, the dead space that can involve postoperative complications. The purpose of this study is to demonstrate that with or without drainage the complication rate is unchanged. METHODS: We conducted a retrospective and comparative study of two groups of breast reduction with and without drainage. Every complication has been recorded and statistically analyzed: seroma and hematoma, infections, wound breakdown, skin flap or nipple-areola complex necrosis, fat necrosis and reoperation. RESULTS: A total of 138 breast reductions were performed (37 drained patients and 32 non-drained). Data collection of complications was done on average 10months after the operation (1-15). There was no statistical difference between the two groups regarding the complication rate. Our results confirm the ones found in the literature. CONCLUSION: Except for specific cases (e.g. gigantomasty), this study demonstrates that after breast reduction, drainage is not appropriate. Drains do not reduce postoperative complications and can increase hospitalization length of stay (inducing higher costs). Furthermore, it is often source of pain, anxiety and discomfort for patients.

[Abdominoplasty: towards a two procedures surgery? Retrospective study of postoperative complications about 100 cases]. / L'abdominoplastie: vers une chirurgie en deux temps? Etude rétrospective des complications postopératoires à propos de 100 cas.

Abdominoplasty has become in France a frequent, appearing to be technically easy but nevertheless source of potentially serious complications clearly deteriorating the aesthetic results and the satisfaction rate of the patients. By studying the results of a hundred abdominoplasties performed between 2001 and 2004, we could count the incidence of the various complications by seeking their possible factors of risk (tobacco or ponderal overload). In spite of the use of a lymphatic preserving technique, the percentage of séroma reaches 12%. The high complications rate or the number of insufficient results explains a rate of surgical reoperation of 31%. Abdominoplasty passed from the statute of repairing surgery to that of aesthetic surgery. The level standard in terms of result became equivalent to the other purely aesthetic interventions. Obtaining an optimal result thus requires often two operational stages, data element that it henceforth seems essential to us to provide to the patients.