Drainless Gynecomastia Surgery

A recurring question regarding the surgical treatment for gynecomastia is whether drains are necessary during recovery. Many of my colleagues continue to use drains for gynecomastia surgery and this is a perfectly acceptable approach. However, in an effort to improve the patient experience and streamline recovery, we have critically evaluated routine drain use and incorporated these findings into our practice.

The simple answer is that drains are not routinely necessary.

In my practice, we do not routinely use drains. Instead, I recommend continuous compression which is applied in the form of a specialized garment with lipoplasty foam inserts. The compression is intended to be maintained for about 72-hours post surgery, after which the garment may be removed and laundered. The lipoplasty foam inserts are discarded and the compression garment is used for an additional 4-weeks.

In 2014 Keskin et al published their retrospective on 138 consecutive cases of gynecomastia correction with liposuction combined with a pull through technique and found no increase in adverse events (Keskin et al. Necessity of suction drains in gynecomastia surgery. Aesthet Surg J. 2014 May 1;34).

The 2022 Clinical Practice Guidelines (CPG) issued by the American Society of Plastic Surgeons (ASPS) with regards to routine drain usage after breast reduction surgery found no benefit to routine drain use. Although not exactly the same procedure, breast reduction can be reasonably viewed as the analogous procedure to gynecomastia surgery in the opposite sex.

The CPG was based on a review of three prospective randomized trials conducted between 2003 and 2009. In my approach to breast reduction, I prefer to use drains on a case by case basis. However, in the majority of breast reduction cases, I do not use drains and have found no difference in recovery or the incidence of seroma.

Furthermore, our practice is committed to the science and philosophy of Enhanced Recovery After Surgery (ERAS). This is an approach to streamline recovery from surgical procedures pioneered by our colleagues in colorectal surgery. One of the principles of ERAS is to minimize the use of surgical drains. A recent study from Harvard found that surgical drains were associated with increased pain; increased difficulty in completing daily tasks; and adversely affected the mood of the patient (Gadiraju GK et al. Understanding the Impacts of Surgical Drains on Postoperative Pain and Quality of Life. Plast Reconstr Surg Glob Open. 2025 Jan 27;13(1):e6474). By minimizing drain use, we reduce reliance on opioid pain medications and increase patient comfort.

Based on the current evidence as well as Clinical Practice Guidelines for similar procedures and my personal experience with breast and gynecomastia reduction surgery, I elect not to routinely use drains in gynecomastia procedures.

Pravin Reddy, MD FACS

Dr. Reddy is Board Certified Plastic & Reconstructive Surgeon. He is a Fellow of the American College of Surgeons and a member of the American Society of Plastic Surgeons.