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Incisional Drainage or Lymphatic Drainage?

Nicole Luckey, LMT, CLT

Apr 19, 2023

The Origin and Threat of Incisional Drainage in Post Cosmetic Surgical Care

The Origin and Threat of Incisional Drainage in Post Cosmetic Surgical Care

In a world with increasing popularity of cosmetic procedures, there should be attention paid to the after care and recovery. Body altercation surgeries have become more radical throughout the 21st century, now involving muscle dissection, foreign body injection, and prosthesis. The swelling and fibrosis (hardening) that is brought on by the trauma to the tissues becomes evident very shortly after procedures. Surgical teams select treatments for post-op swelling from a broad range of medications, and modalities. One controversial yet increasingly popular modality in use today is incisional drainage. 

Many Central and South American Countries, led by Columbia have adopted this post surgical treatment for swelling. It is used as a non-surgical body sculpting method. It became favored in the body modification ethnology. It was adopted as a way of reducing excess fluid after surgical procedures such as “brazilian butt lifts”, liposuction, and tummy tucks. It was introduced to America in a fad-like fashion and was booming in Hollywood. It now has inflating popularity in Florida, and New York. It is now used by select cosmetic surgeons throughout most of the U.S.

Incisional Drainage VS. Manual Lymphatic Drainage

Incisional drainage as the name implies is the deliberate and physical pushing of lymphatic fluid out of the incisions made by surgeons. This may involve the reopening of incisions to drain fluid. This is described as feeling uncomfortable, and often painful. Surgical teams do this and place tubular drains to reduce fluid build up. In an NIH article regarding postoperative lymphatic leakage it is stated that, “Leakage of lymphatic vessels” (fluid build up) “may lead to dehydration, nutritional deficiency and immunologic dysfunction… At the same time, it will also increase the infection rate…”

It is indisputably illegal for Massage Therapists to perform incisional drainage unless operating under a nursing or other appropriate medical license in a facility with proper biohazard disposal equipment and procedures. Unfortunately although this is illegal it is still being performed rather publically in some locations that are eventually fined and shut down. Incisional drainage is performed in surgical clinics. The surgical team then recommends that their patient find someone to perform “manual lymphatic drainage” without explanation of the difference between the 2 modalities or without informing the patient that this is typically not performed legally or safely outside of the clinics.

Incisional drainage is associated with a higher instance of infection and severity of fibrosis. The reopening of incisions creates more prospect of infection and stunts/restarts the healing process creating more scar tissue. Where there is healing there is inflammation. The body sends out cells through blood capillaries to carry out many healing jobs. These jobs all create cellular waste. Your lymphatic system responds by picking up this cellular debris, this presents visually as swelling. The lymph picks up the debris and any foreign bodies or pathogens and carries it through a series of tubes and clearance points, eating up potentially harmful things and returning the fluid to the blood then kidneys. Excess fluid is naturally removed through urine! Your body has a plan for the fluid in swollen areas although it can certainly get stagnant, stuck or overwhelmed. For this manual lymphatic drainage (mld) should be performed. MLD is a gentle rhythmic pumping massage over and towards lymph nodes that stimulates your lymphatic system to move stagnant, stuck, or excessive fluid. It shows shocking efficacy when performed by a mld therapist that has thorough training. Anyone who has had a procedure should ensure their therapist is trained and experienced specifically in post surgical manual lymphatic drainage.

What is Fibrosis and how does it form?

In the following weeks to months following a surgery it is very common to get fibrosis which means hardening of the tissues. The lack of blood flow results in decreased delivery of oxygen and nutrients to the area that can cause cell death or hardening. This cell death is what is often referred to in body modification culture as fat necrosis. Where there is tissue damage like a surgical incision your body lays down fibers (primarily collagen) to repair. This process agitates and swells the surrounding tissue. If there is an excess of collagen, or it grows abnormally this can cause fibrosis. The reactivation of the healing process caused by incisional drainage can create this collagen build up and a static state of inflammation that restricts blood flow, and blocks the flow of lymph.

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