Managing Your Surgical Drains Following Breast Surgery

Surgical drains have an important job to do; they keep fluid from collecting in the surgery incision area. When fluid is allowed to collect in a wound it can interfere with healing, cause pressure on the incision site, and create an environment where bacteria can grow and cause an infection.

If you are going to have a mastectomy or reconstruction surgery, you will need one or more surgical drains to remove fluid from your wound site(s).

If you are having both a mastectomy and lymph node dissection, you will have two drainage tubes.

You will not need a drainage tube if you are undergoing a surgical biopsy, or a sentinel node biopsy.  Usually a drainage tube is not needed following a lumpectomy, except when a lymph node dissection is done at the same time. When this is the case, the surgeon will make an incision that is 2 to 3 inches in the skin crease under your arm.

Since I did not need a drain with my first breast cancer, which was treated with a lumpectomy, surgical drains were a new experience for me following my second breast cancer surgery.

When I woke from my bilateral mastectomy, the recovery room nurse reminded me that I needed to be careful of the surgical drains extending out from under my bandages on my left and right sides. That was the beginning of my managing surgical drains for the next 14 days.

While there are different types of surgical drains, the one that is most often used for breast surgeries and the easiest to use is the Jackson-Pratt drainage system, which has been in use since the 1970’s.

It is a flexible tubing attached to a soft, plastic bulb with a stopper. The flat white drainage end of the tubing is put into a small opening near your surgical cut and a stitch holds it in place. The rest of the tube is outside your body and attached to the bulb which catches and hold the fluid. When the bulb is compressed and the stopper is in place, a vacuum is created causing the constant suction needed to draw out the fluid collecting under your surgical incision.

While I needed my drains for 14 days, some women may need them for less time and others will need drains longer. It all depends on the type of surgery a woman has and the amount of fluid that continues to drain. Drains are usually removed when the drainage is 30 milliliters or less over 24 hours. Tracking your drainage and recording it in a log is very important in helping your surgeon determine when it is safe to remove your drain.

Going Home with Surgical Drains:

Going home with drains and being able to function comfortably begins with planning before your surgery. Know that in addition to coping with pain, and limited range of motion for a while, you need to secure your drain so it is not just swinging freely from your wound site.

While recovering, your incision sites will be tender and sensitive. If the suture holding the drain in place is constantly tugged on, it could become quite painful for you. While you can use pins to fasten the drains to any article of clothing, there is a better way

• Buy drain management garments that you can wear when you get home.  Prior to my surgery, my breast surgeon suggested a visit to a boutique that specializes in breast surgery clothing. She gave me a prescription for a camisole made of cotton that had no internal seams to irritate my skin and 2 small pouches to hold the bulb parts of my drains securely. The camisole also had pockets where I could insert soft cotton breast forms that gave me a little shape as I recovered. I bought two camisoles so I always had one to wear while the other was in the laundry. These camisoles were attractive looking, very comfortable to wear, and held my drains in place.
• Have several big shirts, roomy blouses, sweaters, and sweatshirts that open in the front that you can wear comfortably until the drains are removed. Don’t wear anything you need to pull over your head.
• Take an inventory of what you think you will need to use daily, and put it within easy reach so you will not be forced to stretch or pull and create a problem with your drains.
• If your insurance covers it, and many policies do, your doctor can order visiting nurse service to come to your home, change your dressings and instruct you in how to manage your drains on a daily basis, including:
  • How to empty your drain bulb
  • Checking to see if the bulb becomes full during the day, and emptying it more frequently than the recommended 2x per day, in the morning and just before bed
  • How to clean and compress the bulb, once emptied, to create the suction needed continue to draw out the fluid from your surgical site.
  • Measuring fluid emptied from the drains
  • Keeping a log of the amount and the color of the fluid emptied each time, for each drain
  • Caring for the area where the tube goes into your skin, and checking it for signs of infection
  • Keeping the drainage flowing in the tubing when clots form
  • Recognizing you have a problem with your surgical drain
  • Knowing you need to call your surgeon when:
    • Your drainage is bright red
    • You are running a temperature of 101° F (38.3° C) or higher
    • There is increased redness, tenderness, swelling, or pus where your tube is inserted into your surgical site
    • A large amount of fluid is leaking from where the drain tubing is inserted into the surgical site.
    • You get a large increase in fluid drainage within 24 hours from the previous measurement; or your drainage output suddenly decreases or stops entirely
    • Your drain falls out.
• Consider how you are going to sleep with a drain in you. You need to keep from rolling on it, and possibly dislodging it. Since I had drains on both sides of my body, I could only sleep on my back. I woke the first morning I was home to find I had damaged the drain on my right side, which needed immediate medical intervention. For the next 13 nights, I slept in a recliner chair that kept me from rolling on my side.
• Until you are given medical clearance to take a shower or a bath, you are limited to sponge baths. Bending forward over the sink to wash your hair hurts. Treat yourself to a shampoo at a hair salon. Leaning back over a sink from a seated position, with your front kept dry underneath a plastic cover is the way to go.
• Given that you will have weight restrictions, have groceries delivered or have someone, who can carry heavy packages, come with you to the store.
• You cannot drive with a drain in you. When your ride in a car, as a passenger, it is a good idea to put a soft pillow between you and your seat belt. Position the pillow to cover your surgical site and the drain.

Having Your Drain Removed

After walking around for about 2 weeks, feeling chained to drains that need daily care, the thought of being drain free may just reduce any anxiety you may feel about having them removed. Your surgeon will remove your drain(s) during a visit to his or her office. Having a drain removed can be best described as a pulling or stinging sensation, which only last a few minutes.You don’t need pain medication for this procedure.

Once your drain is out, you can wear your own bras. Just remember, don’t wear any underwire bras.The bras need to be supportive, comfortable, and not too tight.