Amount of Blood Drained after Pre-Pectoral Breast Implants. Analysis of a Cohort of 30 Patients Submitted to Primary Breast Augmentation with Silicone Gel Implants

Goals/Purpose: The use of tubular drains in silicone gel breast augmentation remains a source of debate up to the risk of hematoma and capsular contracture as opposed to the risk of infection and the patient’s intolerance. The objective of the study was to determine the amount of blood drained after pre-pectoral breast implants.

Methods/Technique: We retrospectively analyzed a cohort of 30 females under 45 years old, submitted to a first aesthetic breast augmentation by pre-pectoral silicone smooth gel implants as solo surgery during 2011 and 2012.  Patients with any disease and/or intake of any medication compromising coagulation or bleeding were excluded from this study. All of them were operated by the same surgeon with 20 years’ experience in sub-pectoral technique, during 2011 and 2012. The patients were operated with general intravenously anesthesia and local infiltration with lidocaine and vasoconstrictors. The surgeries were performed by means of an inframammary incision. It was used a 4,8-mm bilateral tubular suctioning drain system until 72 hours post-surgery. The implants used were silicone round moderate projection type, with smooth envelope, gel filled with a constant brand. The amount of blood was collected and noted every 24 hours by the same method, with a 20-cc syringe. Patients were followed with a maximum of six years and a minimum of three years. All patients were submitted to magnetic resonance after three years of implantation.

Results/Complications: The mean age of the patients was 27 years (18-44). There were no complications during the procedure. The total amount of blood drained was from 86 cc to 355 cc, (normal distribution, average 187 cc); 56% of the total amount drained after 24 hours, 27% after 48 hours and 17 % after 72 hours. There was no hematoma, seroma, infection and capsular contracture. The patients didn’t present bruising in the breast region. The resonance magnetic exams were considered normal for all the patients. One presented a small amount of liquid around the implant, one side after four years. 

Conclusion: It is important to observe the unexpected large amount of blood collected even the patient presented no risk factors and submitted to a procedure with careful hemostasis and aseptic technique. The absence of late seromas, hematomas or dense capsule formation, even in this small number of participants suggest the necessity of drainage for breast implants. It’s important to emphasize the silicone characteristics as an inhibitor of clot formation that may result in a long-time presence of no coagulated blood around the implant. In the 1980’s, we observed the presence of fibrin and uncoagulated blood around tissue expanders in the removal surgery step, 3 to 6 months after introduction and It was the first opportunity to understand the behavior of the presence blood around silicone. Based on our results, we emphasize the importance to perform more prospective studies regarding drainage after breast augmentation with silicone implants.