I had bilateral mastectomy and reconstruction with TEs April 3, 2012 and it is now May 7 and I still have 2 drains. My PS won't take drains out until the 24 hour total is 15cc or less for at least 2 days. I have kept the site clean and clear of infection but it's getting extremely sore. I have maintained a 24 hour output of 20cc for over a week but my PS still will not remove these drains. I guess each PS has their own drain output requirement before removing and there's no set amount, right?
How Long Do Jackson Pratt Drains Stay in After Bilateral Mastectomy?
Doctor Answers 1
Deciding when to remove drains after bilateral mastectomy
You are right when you say that every PS individualizes when to remove the drains. Some of the decision making depends on the actual technique of TE reconstruction. If an acellular dermal matrix, like Alloderm or Flex HD, is used, fluid collection can be a more common problem, and may be associated with additional time to have the drains removed. The concern with early drain removal is that if fluid does collect around the TE, it can be associated with infection around the implant or delayed healing of the incisions, and that might compromise the first stage reconstruction.
Generally, the guidelines are less than 30-50 cc/24hr per drain. While a month is a long time to have drains, it is not out of the range that we occasionally see. There is always a concern about keeping the drains in past 4-5 weeks because of local discomfort or the concern that the drain site might be a pathway for infection. Have an open discussion with your PS about the risks and benefits of continuing or removing the drain at this point. With only 20 cc or drainage per 24 hr it is not unreasonable to make the consideration to remove them.
Good luck with your reconstruction.
Stephen Harris, MD