Surgical Drain Care and Follow-Up After Breast Surgery

woman looking in mirror
imagenavi/Getty Images

If you are having a mastectomy for breast cancer you may have surgical drains in place when you go home. Surgical drains are also usually placed during breast reconstruction surgery. Your surgeon or her nurse will give you instructions on how to manage your drains when you go home, but there are a few things you can do ahead of time to make living with drains a bit easier.

Here's what you need to know about drain care and follow-up.

Overview

After you have had breast surgery, surgical drains perform an important role in healing. Fluid often builds up in the area where a breast is removed, and if this fluid is not removed it can result in painful pressure and delay healing. Drains also reduce the chance that you will develop a seroma, a collection of fluid which can be uncomfortable and sometimes cause scarring. For this reason, your surgeon will place drains in the regions where fluid would be expected to accumulate.

There is a trade-off between allowing fluid to accumulate and the risk of an infection from having a drain in place. Drains offer bacteria a way to enter the body, and keeping the area around your drains dry and clean will be important.

Most drains are left in place for 2 to 3 weeks, but some may be removed before you leave the hospital and others may need to be left in place for longer than 3 weeks. The risk of infection, however, begins to increase rapidly after they have been in place for 21 days.

Surgeons vary with how long they recommend drains stay in place, with many surgeons recommending a drainage of less than 20 to 30 cc total per 24 hours as the cut-off.

Breast Surgeries That Typically Require Surgical Drains

Surgeries which require drains are those in which fluid is expected to collect during healing.

Drains are usually required following a mastectomy or reconstructive surgery. You may have only one drain, though you may have five or more if you have a bilateral mastectomy with immediate reconstruction. A separate drainage tube is often placed if you have a lymph node dissection.

The location of your drains will depend on the surgery you have, but often includes a drain at your mastectomy site and one in your armpit if you have lymph nodes removed.

You will not usually need a drainage tube if you are undergoing a  surgical biopsylumpectomy, or a sentinel node biopsy. If you are found to have positive sentinel nodes and a lymph node dissection is done, however, you will likely wake up with a drain in place.

Types of Surgical Drains

While there are different types of surgical drains, the type used most often for breast surgeries is the Jackson-Pratt drainage system. These drains are placed within your surgical field and are attached to flexible tubing which passes through and is stitched to your skin. Outside of your body, it ends with a soft plastic bulb with a stopper. The bulb is the area which catches and holds the fluid which is removed.

How to Care for Surgical Drains

When You Wake Up From Surgery

When you wake up from surgery, your recovery room nurse will remind you that you need to be careful with your drains. Depending on the length of the tubes (usually 14 to 18 inches) it's easy to get these tangled up with IV lines, your bedclothes, and anything else nearby.

Early on your nurse will periodically drain your bulbs and will begin to teach you how this is done. She will begin a log book charting the amount of drainage from each tube, and this process will continue until your drains are removed.

Before you leave the hospital your health care team will review drain management, tell you about symptoms that should prompt you to call and set up a follow-up visit to have them removed.

 

Keeping Your Drains in Place

One of the most difficult parts of having surgical drains is managing both the tubes and the drainage collection ports. Without a little forethought, this can feel clumsy and you might risk accidentally pulling out a drain before it has done its job.

Having a special drain management garment can be a lifesaver, and is a gift many breast cancer survivors choose for their friends who have been diagnosed. There are special cotton camisoles designed just for this purpose. A good camisole has pockets or pouches where you can insert the bulbs to keep them secure, is sturdy enough to attach and reattach safety pins to control the lines, and minimizes seams which could rub against your incision sites and be uncomfortable. This keeps the drains secure so they don't pull on your wound site or swing freely where they could catch on objects as you pass by. Some camisoles even have pockets in which you can insert soft cotton breast forms if you desire.

Other options include large, roomy blouses, and oversized sweaters or sweatshirts that open in the front. For some time after surgery it may be difficult pulling clothing over your head, so keep this in mind when you shop. When you go to sleep at night, pay attention to the location of your drains. If you are an "active sleeper" you may need to sleep on your back or in a recliner to prevent dislodging your drains. Learn more about post-mastectomy clothing.

Emptying and Tracking Your Drainage

It is very helpful to have someone assist you with draining your surgical bulbs. If you live alone, it's helpful to arrange to have someone with you when your drains need to be emptied.

Your surgical nurse will demonstrate how to measure your drainage, and remind you to wash your hands before and after each measurement. Early on you'll likely have around 100 cc drainage per day, but this will steadily decrease. You may be asked to empty your drains two to four times daily, but you should do this more frequently if they become two-thirds full.

After you have emptied your drains you should also look at the color and consistency of the drainage. Early on your drainage will be bright red but this changes to a straw colored and thinner look after a few days. After emptying your bulb, gently compress it to make sure a vacuum is re-created when you close the system.

The amount of drainage you have will gradually decrease, but you might have times when you notice an increase in drainage. If this happens, think about what you have been doing. Increased drainage may be a sign that you've overdone it and need to take it easy for a few more days. Take time to inspect the area where the drain enters your skin to watch for signs of infection.

Living and Moving Around With Drains

It's far too easy to catch your drain tubes on anything you walk by if they are not secure. Stretching and pulling can also be restricted for some time after surgery, especially with drains in place. Before your surgery, it's helpful to place commonly used options in a place where you won't have to stretch or bend to use them.

You will probably have a weight restriction, so make sure to take someone with you if you head to the grocery store. Surgeons differ as to recommendations about driving with drains, and some recommend avoiding this altogether. You should also avoid driving if you are taking pain medications. When you ride in a car as a passenger you may wish to position a small, soft, but relatively flat pillow between your surgical site and drains and your seat belt.

Your surgeon will let you know how long you need to wait to bathe after surgery. Physicians also differ with regard to bathing instructions. Some recommend you only do sponge baths until your drains are removed, though you may be able to to use the shower head to wash from your waist down.

Washing your hair can be a bit of a challenge due to limited motion of your arms and it can be uncomfortable to lean over the sink. Some people find that treating themselves to a shampoo at a hair salon is a good option.

Soaking in a tub or entering a hot tub is not recommended while you have drains in place.

Common Drain Problems

There are a few problems you may encounter while you have drains. These include:

  • Increased drainage: Some people note increased drainage if they are too active, while others don't find this to be the case.
  • Clots in the tubing: On occasion, people will find a clot in their tubing. If this occurs, try gently kneading the area.
  • Loss of vacuum pressure: If a proper vacuum isn't created after emptying your bulb your drain may fail to remove fluid. If this occurs, the build-up in fluid can be uncomfortable.
  • Infection: Drain site infections are not uncommon and are more likely the longer your drains are in place (see below).

Signs and Symptoms of Infection

Having drains provides bacteria an access route to your body, and the longer drains are in place the greater the risk of. This becomes more concerning when they have been in place more than 21 days. Signs of a drain-related infection may include:

  • A fever with a temperature of 101° F (38.3° C) or higher
  • Redness of your skin surrounding the drain
  • Hardness or firmness where the drain exits your body
  • Thickening rather than thinning of your drainage
  • Foul smelling drainage when you empty your drain bulb, or pus at the entry site
  • Pain or discomfort at your drain sites

When to Call Your Doctor

You should call your surgeon if you have any concerns or questions at all, or if you develop any of the following problems:

  • If your drainage is bright red for more than two or three days
  • If you develop any signs or symptoms of an infection as noted above
  • If a large amount of fluid is leaking from where the drain tubing is inserted into the surgical site
  • If your drainage output suddenly decreases or stops abruptly
  • If your drainage becomes thicker rather than thinner as time goes on
  • If your bulb loses suction
  • If your drain falls out

Having Your Drains Removed

Surgeons vary on the amount of time they want drains left in place. Most recommend drains be removed when there is less than 20 to 30 cc total from a drain in 24 hours. If you are still having more than 30 cc draining but the drain has been in place for 3 weeks, the risk of infection appears to outweigh the benefit of leaving drains in place any longer.

After walking around with drains for a few weeks the thought of being drain-free often reduces any anxiety about having them removed. Your surgeon will remove your drains during a visit by cutting the suture holding it in place and gently pulling out the tubing. You may notice a transient pulling sensation but this only lasts a few minutes. Most people do not need any pain medications for this procedure.

Once your drain is out, ask your surgeon what undergarments she recommends you wear. Your bras should be supportive, comfortable, and not too tight. Underwire bras should be avoided.

You will have small scars where the tubing excited your skin, but these often fade in time.

A Word From Verywell

If you have a mastectomy or breast reconstruction, you will likely have surgical drains in place when you wake up. These drains function to remove fluid build-up in your chest which could place pressure on your incision or raise your risk of developing an infection.

Life can be a bit limiting with drains, but some forethought can make this much easier. If you are planning your mastectomy, we have other ideas as well for planning ahead.

Drains can also be a way to monitor your healing. As your drainage decreases each day you can imagine yourself being a day further away from cancer.

Sources

Chen, C., Lin, S., Hung, C., and P. Chou. Risk of Infection is Associated More With Drain Duration Than Daily Drainage Volume in Prosthesis-Based Breast Reconstruction: A Cohort Study. Medicine (Baltimore). 2016. 95(49):e5605.

Thomson, D., Trevatt, A., and D. Furniss. When Should Axillary Drains Be Removed? A Meta-Analysis of Time-Limited Versus Volume Controlled Strategies for Timing of Drain Removal Following Axillary Lymphadenectomy. Journal of Plastic, Reconstructive, and Aesthetic Surgery. 2016. 69(12):1614-1620.

Continue Reading