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“I am healing OK from my double mastectomy, but these drains hurt a lot sometimes, and I can’t wait to get them out,” shared one MyBCTeam member. Many people have expressed similar sentiments about drainage, but you might wonder exactly what to expect.
For instance, does everyone get drain tubes after a mastectomy? If so, how do you care for them, and when can you get them removed? We’ll review why drains are used after a mastectomy, how to manage them at home, and when they’re typically removed.
After a mastectomy, fluid can build up in the space where your breast tissue used to be — it’s part of the body’s normal inflammatory response. The fluid typically consists of white blood cells, proteins, and waste products (also known as blood plasma and lymph). Healthcare professionals call this accumulation of fluid a seroma.
Some mastectomy seromas can become infected, develop a hard shell, or cause misshapen breast implants. To prevent seromas from having these complications, surgeons often place one to five drainage tubes after a mastectomy. The pencil-width tubes are secured to the skin with one or two stitches.
The tube is about as long as your arm, and it ends in a bulb the size of your hand. Air is squeezed out of the bulb before it’s capped, creating a gentle vacuum that helps drain the fluid.
Simple mastectomies and radical mastectomies with immediate breast reconstruction may not require drains. Researchers have found that certain kinds of mastectomies are more likely to cause seromas than others. Fluid buildup is common after a mastectomy, but not guaranteed.
Larger surgery areas and longer surgeries, like mastectomies with flap reconstructions, may increase the risk of seromas, which can make it harder for your body to heal.
Because drains can be painful, your surgeon may choose not to place any if you face a low risk of seroma. Talk to your care team if you have any questions or concerns about the use of mastectomy drains.
The fluid that drains from your mastectomy tubes will change over time. It’s normal for it to appear thick and bright red at first. It should gradually thin out and turn yellowish before becoming clear.
You may have an infection if the drainage thickens rather than thins. Infected drainage also tends to smell bad and look milky, greenish, or creamy.
Other signs of a postmastectomy infection include:
Mastectomy drains remain in place until 25 to 30 cubic centimeters (about 2 tablespoons) of fluid is drained per day for two days in a row. This usually takes one to three weeks, but everyone heals at their own pace so don’t worry if the drains are left in for more than three weeks; that can be completely normal.
“Luckily I got mine out after one week.”
“Fifteen days post double mastectomy and all drains gone!”
“Nineteen days postsurgery, finally getting the drains out tomorrow!”
“I had one for three and a half weeks and one for six weeks.”
“Drains coming out today after four long weeks post tissue expander surgery.”
“I had my drains from mastectomy surgery for 12 weeks.”
The risk of infection increases the longer drains stay in place, but removing drains too early can also cause complications. In any case, your surgical team will consider the risks and benefits. Talk to your care team if you have any concerns about mastectomy drain removal.
Removing drains after mastectomy is quick and painless. A nurse cuts the stitch, then pulls the tube out in one smooth motion. It might feel weird, but it shouldn’t hurt.
The hole will be covered with gauze and should heal up in just a few days. It doesn’t need stitches.
Mastectomy drains require daily care to prevent infection and monitor fluid output. Your care team should show you how to empty and reset the drain bulb before you leave the hospital.
Here’s a quick guide:
1. When the drainage bulb is about half full, remove the cap and pour the fluid into a measuring cup.
2. Record the amount of fluid, fluid color, fluid consistency, date, time, and any other detail that catches your attention, on a chart provided by your care team.
3. Flush the fluid down the toilet.
4. Rinse the bulb with water to clean it and flush the water down the toilet.
5. Gently squeeze air out of the bulb.
6. Reattach the bulb cap and/or reattach the tubing.
7. Place the bulb in a pocket or use a pin to secure it to your clothes.
Repeat with each drain as needed.
You also need to care for the drain insertion site every day:
1. Wash your hands.
2. Carefully remove the old dressing.
3. Clean the skin around the drain insertion site with soap and water. You may need to do this with a towel if you’re not allowed to shower yet.
4. Gently pat the skin dry.
5. Note any changes in your skin’s appearance. A reddish area around the stitches is normal.
6. Apply a new dressing according to your care team’s instructions.
Your surgeon will ask you to avoid certain tasks while your drains are in place. These restrictions prevent the drains from falling out or becoming infected and should help you heal faster in general.
Typically, you won’t be able to do the following until your mastectomy drains come out:
Living with a mastectomy drain isn’t always easy, and sometimes issues arise. Here are some common problems to watch for.
“I’ve had issues with my drainage tube having some clots,” one MyBCTeam member writes. It’s normal for dark, thick tissue strings to enter the tube, but sometimes these clots can cause a blockage.
You might be able to manually move the tissue into the bulb. This is called milking or stripping the tube. Hold the tube near its insertion point with one hand to stabilize it. With the other hand, pinch the tube and slide your fingers toward the bulb. Think of it as massaging the clots to break them up.
Try this technique two or three times. If your tube still won’t drain or if you don’t feel comfortable doing it, contact your care team.
One or two sutures hold a mastectomy drain in place. They may rip if the tube gets caught on something, causing the drain to fall out of your chest.
Don’t try to push the tube back in, even if it hasn’t completely fallen out. If you try to push it back in, you can get skin bacteria inside your mastectomy wound. Instead, tape a clean piece of gauze over the drainage hole and call your surgeon immediately.
Drains often come with a tab that can hold a safety pin. Pin the bulb to your clothes to keep them up and out of the way. “Without proper support, it can be uncomfortable,” writes one MyBCTeam member.
When you shower, wear a lanyard around your neck. Pin each bulb to the lanyard so they don’t hang loose and pull on the stitches.
You can also buy special postmastectomy camisoles. These button-up shirts have pockets on the inside to hold drain bulbs, and they’re easy to put on without lifting your arms.
You’ll need to sleep on your back until the mastectomy drains are removed. Lying slightly reclined is better than lying flat because it’s easier to get up without straining the surgical site.
Try sleeping in a recliner with a mastectomy pillow. This helps you stay propped up, supports your arms, and makes it tough to roll onto your side or stomach. You’ll lower your risk of pulling your drains out when you can’t roll around in the middle of the night.
“I will sleep a lot better not having to worry about the tubing or the bulb tugging when I move,” says a MyBCTeam member.
On MyBCTeam, people share their experiences with breast cancer, get advice, and find support from others who understand.
What are some hacks that have made it easier to manage your mastectomy drains? Let others know in the comments below.
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