Comment to: Quilting Sutures and Suction Drains in Preventing Postoperative Complications in Gynecomastia Surgery

Dear Editors, We read with great interest the article entitled ‘‘Quilting Sutures and Suction Drains in Preventing Postoperative Complications in Gynecomastia Surgery’’ by Amato, Fernando Campos Moraes et al. [1]. In this paper, the Authors compared the efficacy of quilting sutures and suction drains in preventing hematoma and seroma after subcutaneous mastectomy for gynecomastia. We completely agree with the Authors that seroma and hematoma are the most popular complications in gynecomastia surgical correction, requiring surgical revision, especially when adenectomy is in association with liposuction and therefore we really appreciate the Authors’ effort to investigate the role of drains and internal suture in reducing the incidence of complications. Internal quilting is not visible and therefore allows more satisfaction with the result in the immediate post-op resulting less invasive for patients, avoiding any patients’ displeasure due to track of the external marks. Internal quilting has no need to be removed and, maintaining, for a long time a firm connection of the adipo-cutaneous thoracic flap to the pectoralis fascia, they could guarantee a better recontouring of the extra skin onto the new pectoralis profile, especially in the most severe form of gynecomastia. Otherwise, drains could potentially interfere with patients’ post-operative course, causing pain and patients’ discomfort. Although, internal suture, reducing the dead space, and therefore the incidence of post-operative complications of gynecomastia surgery, in the presence of the most severe entity of gynecomastia disorder, such as in patients with large amount of breast gland removal or in the presence of coagulation’s disorder the use of drains should be considered and the final choice for their insertions should be made during the operation. Even if we do not retain the use of drains is mandatory for this type of surgery, unless a valid hemostasis is performed directly, the vacuum drains can cooperate with the internal suture in maintaining a firm contact between the mastectomy flap and the thorax, optimizing the extra skin redistribution and reducing the need of extra areo