Aesthetic Plastic Surgery

, Volume 43, Issue 3, pp 608–615 | Cite as

50 Shades of Red: The Predictive Value of Closed Suction Drains for the Detection of Postoperative Bleeding in Breast Surgery

  • A. M. AnkerEmail author
  • B. H. Miranda
  • L. Prantl
  • A. Kehrer
  • C. Strauss
  • V. Brébant
  • S. M. Klein
Original Article Breast Surgery



While closed suction drains (CSDs) are still frequently employed in clinical practice, the supporting evidence is limited with some studies demonstrating a failure of routine CSD use in preventing hematoma or seroma. Nonetheless, CSD quantity and quality fluid assessment is still appreciated by clinicians to detect postoperative bleeding. This study investigates the value of routine CSD use, in breast surgery, to predict postoperative bleeding.


A retrospective, intra-individual analysis, of CSD fluid volumes between the hematoma side and the unaffected contralateral breast, was undertaken in patients (n = 20) with unilateral postoperative bleeding following bilateral breast surgery (2003–2018). Statistical analysis was undertaken to establish a minimum cutoff fluid volume that might assist in the detection of postoperative bleeding. To determine the usefulness of quality assessment of CSD fluid output by visual inspection, surgeons (n = 56) prospectively matched six eligible hemoglobin concentrations corresponding to pre-filled CSDs.


Statistical analysis did not yield a clinically reliable cutoff fluid volume indicating postoperative bleeding. All six eligible hemoglobin concentrations were completely successfully matched to pre-filled CSDs by 30.4% (17/56) of surgeons.


This study questions the significance of routine CSD use to assist in the decision-making process to return to the theater and address postoperative bleeding. Quantity as well as quality analysis of CSD fluid output failed the reliability and diagnostic validity tests. Hemoglobin measurements in drain fluid specimens via blood gas analysis might contribute to the detection of postoperative bleeding.

Level of Evidence IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors


Closed suction drains (CSDs) Breast surgery Prediction of postoperative bleeding Diagnostic validity 


Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

Institutional research ethics committee approval (Ref. 18-955-104) was obtained prior to the initiation of this study.

Informed Consent

Informed patient consent was obtained.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery 2019

Authors and Affiliations

  • A. M. Anker
    • 1
    Email author
  • B. H. Miranda
    • 2
  • L. Prantl
    • 1
  • A. Kehrer
    • 1
  • C. Strauss
    • 1
  • V. Brébant
    • 1
  • S. M. Klein
    • 1
  1. 1.Center for Plastic, Reconstructive, Aesthetic and Hand SurgeryUniversity Hospital Regensburg and Caritas Hospital St. Josef RegensburgRegensburgGermany
  2. 2.Plastic and Reconstructive Surgery DepartmentRoyal Free London NHS Foundation Trust, Royal Free HospitalLondonUK

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