The DiepCJourney Facebook group has members from all over the world. The purpose of the group is to nurture an ongoing learning community with people affected by breast cancer and those who serve breast cancer patients. A request was made to make a video about surgical drains. It is not a favorite part of recover but certainly necessary. I sat down with Dr. Randall Feingold of NYBRA, New York Breast and Reconstruction and Aesthetic Plastic Surgery to discuss the function and management of breast reconstruction drains.
Why Drains Are Placed at the Surgical Sites
I start off the conversation by sharing my own experience with drains for my double mastectomy and DIEP flap. The general consensus from patients is that drains are not something that anyone likes. I feel when patients understand why they are being used, they become a bit more tolerable, especially knowing they are a short-term part of surgical recovery.
Dr. Feingold begins by explaining that operations such as mastectomy or breast reconstructions that utilize natural tissue such as an abdominal flap like a DIEP flap, a body is going to ooze or secret some fluids at the surgical sites. If a mastectomy is performed even without reconstruction, a surgical drain will prevent blood or fluid accumulation in the first few days after surgery. It also helps tissues heal together by removing fluid that can separate your body’s skin from the breast reconstruction. In the abdominal donor site, when skin and fat are removed for a DIEP flap the skin of the upper abdomen is pulled down snuggly to the bikini area but the skin needs to stick to the muscle of the abdominal wall. The drains elevate any fluid buildup and promotes faster wound healing and prevents infections.
Drain Coloration in the Bulbs and Tubes of Breast Reconstruction
Dr. Feingold answers the question of the color of the fluid in the drain bulbs. Right after surgery, the fluid in the drain appears to be blood. There will be a small amount of blood the first few hours after surgery. Within about one day that fluid begin to get thinner and thinner and not the color or consistency of fresh blood anymore. The body will secrete some serum, the watery component of blood, thereby changing the color from a bright red to a pink color to a softer straw color fluid. This signals the body is going through its appropriate healing phases.
Clotted Material in Breast Reconstruction Drains
When patients strip the drains, usually twice daily, they sometimes notice a bit of clotted material. Out of concern, they ask what is normal and what signals a concern. The drains are cleared to get rid of a bit of debris that can accumulate in the tubing. Dr Feingold tells us the debris is called fibrin, some of the more solid elements that can precipitate of the of serum in the tubing. Patients often mistake it for infection but it is not infection. Sometimes it presents in the bulb as well. It is normal, expected, and benign but stripping the drains daily prevent the drains from clogging allowing them to maintain suction and do their intended job.
Drains for Management of Seromas
Dr. Feingold tells us drains are placed initially during surgery to prevent a fluid buildup, like a seroma, from occurring. However, he also explains there are times when a surgical drain is placed at some point after surgery when the initial surgical drains are removed. This later drain placement can occur if a seroma forms at a later time during the recovery process. He defines this as more of a therapeutic use of the drain vs. the preventative use of the drain immediately after breast reconstruction surgery. A key point Dr. Feingold makes is that he does not want patients massaging a surgical site until the tissues have closed and not promote more fluid accumulation.
How Breast Reconstruction Drains Are Attached During Surgery
The JP (Jackson Pratt) drains anchoring sites have sutures to keep the drains in place until they come out. Patients can develop scarring and have concerns about the look of the scarring. Dr. Feingold encourages women to talk to their surgeon about the placement of the drain exit sites. Some prefer to have the drain to come up higher in the armpit area after a mastectomy as opposed to lower down under the armpit at the level of the breast or the nipple, hiding or camouflaging the scar better. He points out for patients that develop a hypertrophic scar or keloid it may require a steroid injection later on to help soft the mark.
I found it interesting to learn that the scar can be the result of the anchoring suture. Dr. Feingold instructs people when placing the suture is not to tie the knot all the way down tightly to the skin. The suture knot can irritate the skin and become uncomfortable to the patient. It may hurt to cut the knot when the drain is removed. If a surgeon leaves a bit of “air” between the knot and the skin surface there will be less irritation during the life of the drain.
Removing Surgical Drains for Breast Reconstruction
I begin by pointing out how easy my drain removal was. My nurse made it so easy; “one, two, three, deep breath” and out they came. It was easy and I hardly knew it was happening. Dr. Feingold confirms and reassures the listeners this is because the drains are made of a very soft, pliable material. He describes properly placed drains will slip out like the consistency of a wet noodle. Because it is in a moist environment, many patients do not even realize that the drain was removed.
I encourage you to watch the video to see the demonstration and props Dr. Feingold shares with us toward the lasts part of the interview. It is great to see other patients at NYBRA paying it forward. They make a necklace for the shower, pocketed carriers, and drain holders to comfortably wear and manage their breast reconstruction drains. I love the touching story of the “bagels, breakfast, and bulbs” we both chuckle about. Many thanks for your time and expertise Dr. Feingold. This is valuable information about the function and management of breast reconstruction drains.