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Drain vs. no drain when doing a breast augmention

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Posted on November 14, 2025

This blog topic stems from a phone call my assistant got today from a prospective patient. “My friend told me it is super important to use drains when doing a breast augmentation. Why doesn’t Dr. Greenberg use drains?” Valid question. And there are good reasons why I do not.

Why are drains used in surgery?

Drains are round or flat tubes which are placed during surgery into the body. The drain usually has little holes in it inside the body and ends in a bulb, which when collapsed, exerts gentle suction.  Why are they used?

Pro of using a drain in breast augmentation

I must admit, as I have never used a drain for a primary breast augmentation (in my training at Stanford and my breast fellowship in Tennessee none of the surgeons I worked with used drains), I actually googled why people would use a drain in breast augmentation. The result was “Drains in breast augmentation are used to remove accumulated fluids such as blood or lymphatic fluid, potentially reducing early postoperative complications like hematomas and seromas, though their routine use is debated among surgeons.”  

Cons of using a drain in breast augmentation

Let me preface this by saying I use drains in some of my surgeries. But I really really try not to use drains anytime I am putting an implant in. Why?

There are the logistical issues: How do you wrap the breast with the tubes sticking out? How do you get dressed? Shower? My drain is leaking/ not holding suction/ hurts where it goes in the skin.

There are the having to deal with the drain and its surgical loveliness: Oooh. Yuck. I have to empty this? Is that blood?

But the biggest reason for me with breast augmentation to avoid the drain? I am putting in an implant. A breast implant, regardless of if it is silicone gel or saline, is a foreign object. The drain would function as a conduit, a superhighway, from the bacteria laden skin and outside world to my perfect new sterile implant. Which would now not be a sterile implant.

If any bacteria get on that implant, it can lead to a chronic low grade infection called biofilm. Biofilm is established early and once established, cannot be eradicated. Biofilm is thought to be the culprit of capsular contracture (breast implants hardening) and breast implant illness. The only way to clear biofilm is to remove the implant (hence why breast implant removal surgery can help with symptoms of BII).

I throw the kitchen sink at biofilm. I was an early believer in the importance of avoiding biofilm so I have a 14 point process to avoid it, from using Keller funnels for a no touch technique, to having you prep with surgical soap for days ahead of breast surgery, to incision choice and surgical plane choice.

Biofilm causes capsular contracture and breast implant illness?

Yes. It makes sense and now there are published studies which back up the claims.

BIOFILM and CAPSULAR CONTRACTURE

Multiple clinical, experimental, and microbiological studies demonstrate a significant association between the presence of bacterial biofilm—especially from organisms like Staphylococcus epidermidis—on breast implants and the development of capsular contracture. Sensitive culture and imaging techniques consistently show that biofilm is much more frequently detected on implants with contracted capsules than on those without contracture, and the degree of contracture correlates with biofilm presence and bacterial load. Experimental animal models confirm deliberate inoculation with biofilm-forming bacteria leads to a markedly increased risk of contracture, establishing a causal relationship.
Biofilm formation triggers a persistent inflammatory response, which drives fibrotic changes in the capsule surrounding the implant. Reviews and systematic analyses support this mechanism, highlighting biofilm as a key factor and recommending strategies to reduce biofilm formation as a means to prevent contracture. 
BIOFILM and BREAST IMPLANT ILLNESS (BII)
Recent studies demonstrate bacterial biofilm formation on breast implants is associated with immune dysregulation and chronic inflammation, which are central features of BII.
Systematic reviews and meta-analyses support the concept that BII is a multifactorial entity involving immune dysregulation, chronic inflammation, and microbial biofilms, with microbial analysis positive in over a third of BII cases.[4] Removal of implants often leads to symptom improvement, further supporting a link between biofilm-mediated inflammation and BII.

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The information provided on this website is for general informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always seek the advice of a qualified healthcare provider for any questions regarding your health or medical condition.

This blog has been authored by Dr. Lauren Greenberg

Dr. Lauren Greenberg is a Stanford-trained, board-certified plastic surgeon who brings over two decades of experience and a strong commitment to natural-looking results. She is known for combining advanced techniques with an honest, thoughtful approach to help patients feel confident and empowered.

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