What to Know About Surgical Drains After Breast Cancer Surgery
If you undergo an operation for breast cancer treatment or prevention, such as a mastectomy, axillary dissection or breast reconstruction surgery, your doctor may insert one or more temporary surgical drains. These devices can be a bit cumbersome, but they're essential for healing in the weeks following surgery.
Here's what you need to know about how they work and how to manage them.
How do surgical drains work?
Surgical drains are devices that use negative pressure to extract fluids, such as blood, serous fluid and purulent fluid, from the body.
There are two main types used in breast operations: open system and closed system. Each consists of a drain placed within the surgical site attached to thin, flexible tubes (usually 14 to 18 inches long) that transfer fluid to a small container.
With closed-system drains, the container is bulbous, resembling a clear grenade, whereas open-system drains empty fluid directly onto a gauze pad. The closed system, also known as the Jackson-Pratt system, is most common.
The number of drains required depends on the operation type. Some people need only one or two. However, people undergoing a bilateral mastectomy with immediate reconstruction may need five or more. Most people having a lumpectomy, surgical biopsy or sentinel node biopsy don't need surgical drains.
Most patients need to use surgical drains for about two weeks following surgery, or once there's less than 30 cubic centimeters (cc) of drainage in 24 hours. By contrast, you can expect about 100 ccs of drainage per day for the first few days. Your specific timeline depends on the surgical location and individual health considerations. Your drains will be removed by your doctor at a follow-up appointment.
Why are they necessary?
Fluid tends to accumulate in the cavity left by breast tissue removal, similar to how serous fluid leaks from a burn wound. If it isn't removed, it can cause discomfort and impede healing. Drains also decrease the risk of seroma, a cyst-like buildup that can be tender or painful and sometimes cause scarring.
"After surgery, your body may make extra fluid as part of the healing process. If the fluid is not removed with the drain, the fluid can build up," said Lisa F. Schneider, M.D., a plastic and reconstructive surgeon who lives in New Jersey. "This can cause a number of different problems, including a fluid collection, which can require a second surgery to correct, or an infection of the fluid, which can make you sick."
Are the drains uncomfortable?
Doctors usually insert drains while the patient is under anesthesia. Once drains are in place, they can be mildly or moderately uncomfortable, depending on the site location and sensitivity. Large drains are more likely to cause discomfort than small ones.
"Drains are typically not painful. Often, patients report a pulling sensation from the area or stinging around the site of entry," said Vikisha Fripp, M.D., a plastic surgeon based in Washington, D.C.
If your drains are painful, your doctor might recommend using an over-the-counter pain medication, such as Tylenol. However, it's important to avoid nonsteroidal anti-inflammatory drugs, including ibuprofen or naproxen, which can increase bleeding.
How to care for them
Before you leave the hospital, your nurse will demonstrate how to drain the reservoir and log the amount of fluid from each tube. You'll need to do this yourself once you're at home.
"The drain reservoir needs to be emptied periodically, typically about twice a day. Sometimes a patient will be asked to record the amount of fluid output from the drain," said John Abikhaled, M.D., who works for Austin Surgeons in Texas. "Most drain reservoirs provide suction on the drain tube to draw fluid out, so it is important for a patient to know how to reset the drain, so it provides suction. It may also be necessary to change a dressing over the drain."
Your nurse might demonstrate how to "strip" or "milk" the tubes to prevent clogging, as well.
What lifestyle or clothing adjustments are necessary?
Fripp, Abikhaled and Schneider said the most crucial lifestyle adjustment is to avoid intense activity or anything that may pull the drain tubes or cause trauma to the surgical area. Too much physical activity can also increase fluid production.
"A patient should not engage in strenuous or vigorous activity while a drain is in so that the drain is not accidentally dislodged or damaged," Abikhaled advised.
If you tend to toss and turn in your sleep, you might want to sleep in a recliner or lie on your back with pillows on either side to avoid sleeping on the surgical site. Your surgeon might also ask you to avoid showering with the drains.
Some adjustments to your wardrobe can help keep the tubes secure and avoid irritating the drain site with seams or rough fabrics. Loose or oversized shirts or sweatshirts that open in front are ideal. Bear in mind it might be difficult to lift your arms to pull clothing over your head, so look for items with loose straps or that fasten in front.
Several companies make specially designed postsurgery undergarments, including bras, camisoles and belts, that allow for surgical drains, which can make life much easier, too.
With closed-system drains, the container may be placed in the pocket or pouch of a postsurgery bra or camisole or affixed with a safety pin. You can secure the lines to your garment with safety pins to keep them from swinging and potentially catching. Some special camisoles even have pouches where you can insert breast forms.
What complications can arise?
Although one of the primary functions of surgical drains is to prevent infection, they can provide a pathway for bacteria to enter the body. This is why it's important to always wash your hands before and after draining the containers or changing the dressings. Also, keep the drainage site clean and dry by gently washing with soap and water and patting dry.
"Whenever you have any kind of surgery, you should always watch out for the signs and symptoms of infection," Schneider advised.
These signs include excess drainage, pus, swelling, redness, pain, fever, a foul odor, hardness at the drain entry site, a sudden change in drainage smell or color, nausea or vomiting.
Drains, which are usually held in place with a stitch, can also be pulled out by accident, Schneider said.
"If this happens [even partially], don't try to put it back in," she said. "Call your surgeon to get directions for what you should do."
According to Schneider, your surgeon will likely ask you to remove the drain and schedule an appointment to have it reinserted.
Clogs are another potential complication. According to Fripp, possible signs of blockage include no drainage, a sudden decrease in drainage, or fluid accumulating on the gauze around the drain.
Call your doctor right away if any of these symptoms develop.