Surgical Drains After Breast Surgery and What you need to know to prevent infection

By Jean Campbell, MS

If you are having a mastectomy for breast cancer treatment of prophylaxis, you will most likely have surgical drains in place when you go home. Surgical drains are also usually placed during breast reconstruction surgery. Your surgeon or nurse will give you instructions on how to manage your drains, but knowing what to expect can make living with drains a bit easier.

The Purpose of Drains

Surgical drains perform an important role in healing after breast surgery. Fluid often builds up in the area where a breast is removed that can cause discomfort and delay healing if not drained.

Drains also reduce the chance that you will develop a seroma, a collection of fluid that can be uncomfortable and sometimes cause scarring. For this reason, your surgeon will place drains in the regions where fluid is expected to accumulate.

The downside of drains is that they offer bacteria a way to enter the body, so keeping the area around your drains clean and dry is important.

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 that passes through and is stitched to your skin. The tubing is capped with a soft plastic bulb, which catches and holds the fluid, and a stopper outside of your body.

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

Surgeries That Typically Require Surgical Drains

Surgeries requiring drains are those in which fluid collects during healing. Drains are usually required following a mastectomy or reconstructive breast surgery. You may have only one drain, or 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. You will not usually need a drainage tube if you are undergoing a surgical biopsy, lumpectomy, or a sentinel node biopsy.

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.

How to Care for Surgical Drains

When you wake up from surgery, your recovery room nurse will probably warn 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.

Your nurse will periodically drain your bulbs and show you how it’s done. He or she will log the amount of drainage from each tube, and you will be instructed to continue the log on your own until your drains are removed.

Before you leave the hospital, your healthcare 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.

Emptying and Tracking Drainage

Always 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, or whenever they become two-thirds full.

Note the color and consistency of the drainage. Early on, it will be bright red, but this should change to a straw color after a few days. After emptying your bulb into the toilet, rinse it with water and gently compress it to make sure a vacuum is recreated when you close the system. It is very helpful to have someone assist you with draining your surgical bulbs, if possible.

If you notice an increase in the amount of fluid, think about what you have been doing that may be causing that.

Increased drainage may be a sign that you’ve been too active and need to take it easy for a few more days.

Keep the insertion site clean and dry by washing with soap and water and gently patting dry.

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 infection.

Signs of a drain-related infection may include:

• A fever with a temperature of 101 degrees 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 the drained liquid
• Foul smelling drainage or pus at the entry site
• Pain or discomfort at your drain sites
• A sudden change in the smell or color of the drainage

Keeping Drains in Place

One of the most difficult parts of having surgical drains is managing both the tubes and the drainage collection ports.

Having a special drain management garment can be a lifesaver. There are special cotton camisoles designed just for this purpose. A good one 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 that 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 and possibly catch on things. Some camisoles even have pockets in which you can insert soft cotton breast forms.

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 to pull 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 them.

Washing your hair can be a bit of a challenge due to limited motion in 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

Problems that can occur with drains 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, patients 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.

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

Your surgeon will remove your drains by cutting the suture holding it in place and gently pulling out the tubing. You may notice a 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 kind of undergarments he or she recommends. Your bras should be supportive, comfortable, and not too tight. Underwire bras should be avoided.

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

A Word From Verywell

Post-surgical drains can be a nuisance, but they are an important aspect of healing. As the amount of your drainage decreases each day, think of it as signifying being one step closer to being cancer-free.

About the Author

Jean Campbell, MS, is a former writer for Verywell Health covering breast cancer. She is a two-time survivor of invasive breast cancer. Since her first breast cancer 17 years ago, she continues to be actively involved in breast cancer programs and services. Jean is a published book author, magazine writer, and former staff writer for a trade paper. She designs and writes content for websites, blogs, and other print and digital media. In addition to her writings for breast cancer, she is a published author of print and enhanced e-books for young children who are emerging readers.

Article Courtesy of Verywell Health, Illustration by Brianna Gilmartin

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