Surgeon Preferences: Inpatient, Outpatient, Drains, Stitches, Staples & Glue

The information in this section is made available through the generous support of Dr. Grant Stevens and Dr. Luis H. Macias
 

Plastic Surgeon Preferences

Just as we are all different people, each surgeon develops personal preferences during his or her years in practice.

Inpatient/Outpatient

The great majority of breast reduction surgeries are done on an outpatient basis.  This means that you enter and leave the hospital on the same day.

 Many times you will not be given the option of staying longer, unless there is a complication of some sort.  Please be sure to check with your insurance carrier about their guidelines regarding hospital stays.  Frequently, if you need to stay in the hospital for a surgery that was originally scheduled as outpatient, you are going to need to contact the insurance company (generally within 24 hours).  YOU as the patient (or a family member) generally have to do this.  The doctor and/or hospital staff generally do not.  It's important to keep this in mind so please check with your insurance company about their policies regarding this situation before your surgery.

If you are given the option of staying overnight, and your insurance approves that, many women have reported that it was a good choice for them.  They have felt comfortable knowing that there were medical personnel there for them around the clock. It can also be a relief to family care givers who are anxious about caring for a freshly post op patient themselves. 

We also have had members who have felt that going home to their own bed was the best thing for them to do and they had the support they needed arranged with their family or friends.

Try to take all factors into consideration when making this decision.  An inpatient hospital stay does provide around-the-clock care, but it also means a constant low level of noise, nurse visits every 4 hours, and a bed that does not belong to you.  

Going home means your own bed (or couch, recliner, etc.) and pillows, no unusual distractions, and privacy, but there is no medical care at your house.

It all comes down to discussing things with your plastic surgeon, how he does things and weighing your options.

Surgical Center/Hospital

Most breast reductions will be performed in a hospital.  There are some plastic surgeons who perform all of their surgeries in a surgical center. If you are given the option please consider the following:

* Surgical centers are not in a hospital.
* Find out what their policies are regarding emergencies or complications duing surgery.
* Make sure the surgical center is accredited by the accreditation agency in your country.
* Make sure the anesthesiologists are board-certified medical doctors.

There are pros and cons, as usual, with either location.  Once again, it comes down to educating yourself enough to make an informed decision. 

Please note, however, that the fact that there is not an emergency room at the site of your surgical center does not mean you will not receive appropriate care should something go wrong. Your surgical team is trained in all the same emergency procedures as the doctors who do surgeries in a hospital, and all private surgery centers must be accredited to remain open. When you have an emergency in a hospital you are not taken to the emergency room either, incidentally. All surgical centers must meet strict local and national guidelines. It is not less safe to have your surgery in a surgical center vs. a hospital. 

Drains/No Drains

Sometimes hotly contested, the use of drains varies widely by surgeon.  It is believed that drains help significantly with the amount of post-op swelling.  Drains can be left in anywhere from 24 hours to a week.  

Many of our members have reported feeling that they benefited greatly by having drains and an equal amount have said they had little to no drainage.  

As the patient, it is not generally your decision to have or not have drains.  This is something your plastic surgeon does or does not do.  If you have very strong feelings either way, please make sure to discuss this openly with your surgeon.  If the two of you cannot come to an agreement, you might have to consider another plastic surgeon.  It is imperative that you are comfortable with not only your plastic surgeon, but with his or her surgical procedures.

Stitches/Staples/Glue

This is yet another area where the PS makes the decision, not you.  

Staples can leave railroad track type scarring, particularly if left in too long. We find most surgeons moving away from these and this is not our favorite form of incision closing. There have been good results with surgeons who are diligent about when and how to use them and remove them within a short period of time, but again, it's not our first choice and we urge surgeons to use better stitching methods, instead. We are talking about full incision closure using staples that you go home with.

Some very good surgeons will use one or two staples temporarily to hold things together while traditional suturing is being completed. Then the temporary staple is removed before you wake up. 

Glues can be used by themselves or in conjunction with other suture methods. One brand name is 'Mastisol'. Some people can have severe allergic reactions to glue. Unfortunately, finding out after the fact is a horrific experience for a newly pre-op patient. If your doctor plans on using glue on you and you have concerns about it, ask if you can have a patch test first. You do not want to suffer a severe allergic reaction over this widespread and tender area. 

Don't ever be afraid to question your plastic surgeon about what he or she does and why.  This is your body and you have a right to be informed.

  • Friday, 23 March 2012