Surgical Drain Locations After Breast Surgery

Drain Placement After Mastectomy, Node Biopsy, and Reconstruction

If you are having a mastectomy, sentinel node biopsy, or breast reconstruction for breast cancer you will probably have surgical drains placed during surgery. Most people go home with these drains for a few weeks before following up to have them removed. Where are these drains located after the different surgical procedures?

Having an idea of the location of your drains, and what you can expect may help you prepare for managing your drains after breast surgery.

Let's first describe the drains you might have after a mastectomy with reconstruction and then how this may be different if you will be having a mastectomy without reconstruction.

 

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Surgical Drains After Mastectomy and Reconstruction

Surgical Drain After Mastectomy With Implant Reconstruction
Art @ Pam Stephan

When you have a mastectomy or lumpectomy, your surgeon may place surgical drains to help speed up your healing. Without drains, fluid can collect in the space where your breast or lymph nodes had been resulting in pressure and pain. When fluid collects without being drained it may cause a seroma, which may sometimes result in scar formation.

There are different types of drains including grenade drains and Jackson-Pratt drains. You will have a drainage tube and a drainage bulb outside your skin near your surgical incision. Part of the drainage tube will extend inside your body into the surgical area, where it will collect blood and lymphatic fluid. The drainage tube will be held in place with a suture so that it doesn't accidentally slip out.

You will use the drain to remove and measure the fluid several times a day and keep a record of how much blood and lymph is removed. As the volume of fluid decreases, swelling around your surgery site should decrease. When the fluid volume is 30 ml or less in a 24-hour period, you can have the drains removed. Even if you continue to have drainage greater than this, some surgeons recommend removing drains at 3 weeks.

This illustration shows the location of two surgical drains. The model has a sentinel node biopsy to check for metastasis, so there is a drain line close to her armpit. Depending on the results of your sentinel node biopsy your surgeon may also do a lymph node dissection removing further nodes.

The woman in the first image has also had a mastectomy with immediate reconstruction, using a tissue expander. A second surgical drain has been placed around the temporary breast implant to collect blood and lymph. These drains help prevent lymphedema and hematomas from developing.

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Surgical Drains After Mastectomy Without Reconstruction

For people who have a simple mastectomy without immediate reconstruction, there may be only one long incision that includes your lymph node biopsy as well as your mastectomy. Your surgeon may place surgical drains in your incision to help speed up your healing. Some people will have one drain and some will have more. If you have a bilateral mastectomy with lymph node biopsy you may have as many as five or six drains.

Each drain has a drainage bulb and a drainage tube outside your skin near your surgical incision. Part of the drainage tube will extend through your incision into the surgical area, where it will collect blood and lymphatic fluid. Each drainage tube is held in place with a suture so that it doesn't accidentally slip out.

You will take measurements a few times daily of how much blood and lymph collects in your surgical drain. It is important to keep a record of the fluid volume ​because this determines how soon your drains can be removed. The swelling around your surgical site will decrease as you get less fluid out your drains. Early on, the drainage is usually bright red, becoming thinner and changing to a straw-like color after the first few days.

This illustration shows the location of two surgical drains. The model has had a simple mastectomy and a sentinel node biopsy, so there is a drain line close to her armpit as well as at her breast site. She did not have immediate reconstruction. These drains help prevent lymphedema in the arm on the side of the mastectomy as well as hematomas from developing.

The Bottom Line on the Location of Your Drains

Your surgeon may place a drain in a location somewhat different than those in the illustration here, but the concept is the same. Allowing excess fluid to be removed via drains can speed up your healing and get you on the road to recovering from breast 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.

Stoyanov, G., Tsocheva, D., Marinova, K., Dobrev, E., and R. Nenkov. Drainage After a Modified Radical Mastectomy—A Methodological Mini-Review. Cureus. 2017. 9(7):e1454.

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.