Boccara David, Serror Kevin, Malca Nathaniel, Chaouat Marc, Mimoun Maurice
Plastic, Reconstructive and Cosmetic and Burn Surgery Unit, Hôpital Saint Louis, 1 Avenue Vellefaux, 75010, Paris, France.
Aesthetic Plast Surg. 2018 Jun;42(3):908-910. doi: 10.1007/s00266-017-1026-5. Epub 2017 Dec 20.
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.
We carried out a retrospective study in our department in 2016.
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.
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.
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我们阅读了Chao等人发表的题为《男性乳房肥大皮下乳房切除术后的闭式引流：它们能减少并发症吗？》的手稿（《美容整形外科》，2017年。https://doi.org/10.1007/s00266-017-0959-z ）。他们得出结论，引流管可能会降低手术治疗后需要穿刺抽吸的血清肿发生率，但引流管也存在一些不良影响：患者不适、焦虑、费用以及额外的门诊就诊。他们还提到了几个局限性：（1）外科医生决定放置引流管方面的偏差，（2）技术上的细微差别。在此，我们想讨论我们不同的引流技术。为了避免所有这些缺点，我们选择用硅胶片和乳晕周围瘢痕处较宽的瘢痕开口来替代闭式引流管。
我们于2016年在本科室进行了一项回顾性研究。
该系列包括83例患者（153侧乳房），年龄26.7岁（15 - 67岁），平均体重指数为28.6（19.5 - 39）。所有患者均在术后12个月内接受随访。我们在此仅考虑1 - 2a级可触及纤维腺组织的男性乳房肥大。手术过程包括初始吸脂，然后通过乳晕周围入路进行开放性手术切除。我们未发现任何需要干预的血清肿或积液。然而，4例患者（4/153；2.6%）在术后第二天出现需要干预的血肿。
我们的技术具有许多优点，缩短了住院时间、减少了引流管部位护理和门诊就诊的费用、减轻了患者不适以及减少了抗生素处方。
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