How do I get my fluid to decrease after a bilateral mastectomy so I can get my 2 drains taken out?

Question

I am 30 and weigh 150. My Dr. said I would probably be able to remove the drains after 2 weeks because of my size but now I am going on week 3 without not being under 30ml. Is it because I am moving around too much? Is it because I am young? I don't think I am doing anything too hard to push myself and I have been making a conscious effort to stay put and stop doing things. I started in the 60s and it has decreased now to the 40s but I feel like now it is up and down. Am I just impatient?

Richard H. Tholen, MD, FACS · Answer

Another option not mentioned is sclerotherapy via the drain. After mastectomies, lymphatics are often surgically divided, and must heal or regenerate to take that lymphatic fluid away from the operative cavity. So, drainage for an extended period is fairly common. When this happens, time is usually the answer, but both patients and surgeons are impatient creatures, so we are often challenged to "give it a try" and remove a drain when the outputs are still too high (everyone's number is slightly different, and may differ with longer periods of time), but this often leads to seroma, periodic needle aspirations, and eventual drain re-insertion. Bummer!Sclerotherapy is a technique learned during General Surgery training, and is used for surgical situations involving chest tubes, and also mastectomies. Sclerotherapy involves instilling a solution of an antibiotic (not for infection) to irritate and inflame the interior surfaces of the cavity we're trying to seal and heal shut. Tetracycline or Doxycycline are common ones, and aside from being quite irritating, their antimicrobial properties are a "good" side effect, though they are not being used to kill bacteria, but to stimulate inflammation and healing on the lining of the fluid-producing cavity. Downsides are that this is often uncomfortable, so adding some lidocaine to the solution is a good idea. Another downside is that sclero will increase drainage for a day or so, after which we all hope it diminishes enough to have the drain pulled. If the amounts are still high after a week, I repeat the sclerotherapy.Drains are a nuisance. but a nonhealing seroma cavity and more surgery is a much bigger nuisance! Ask your surgeon about sclerotherapy if your drainage amounts are hung up at that too-high number. Best wishes! Dr. Tholen

Chad Robbins, MD · Answer

Drains are the most frustrating and irritating part of the post operative phase of surgery for most of my patients.  I tell them this prior to surgery, that being said, it does not  make it any easier when going thru the process.  Most patients have them in for an average of 3-4 weeks post mastectomy.  Movement or no movement, I feel, doesn't really show much of a difference in affecting the length of time before we get to remove them.  As frustrating as it is, be patient and know they are an important part of the healing process.

Richard J. Brown, MD · Answer

Well, I am sure that too much activity with your arms can lead to increased fluid but there is no scientific evidence of this. The fact is some patients drain less and some drain more. There is no magic bullet as to who will drain less. But, in time you will drain less. You are approaching the time at 3-4 weeks where your surgeon will have to make a decision. I am steadfast about 30cc per day if on exam the patient does not seem to have fluid in the pocket. Being that said if you were draining 60cc's I would not pull them. If you have dropped to 40cc's as you stated then you are heading in the right direction and just be patient. I know having drains stinks but it is a necessary evil. Also, one thing I have done, is if a patient still has the drains at 2-3 weeks I begin filling the tissue expanders which will close that space down and the drains usually slow enough to pull them. I generally do not leave them more than a month and I keep patients on antibiotics the entire time they have them. Be patient; it seems like you outputs are dropping. Not uncommon to keep them for 2-3 weeks. I hope this helps.

Curtis Wong, MD · Answer

I don't have proof but its my feeling that activities do result in more drainage.  In your situation, it would be ranging of your arms or use of your chest muscles in repetitive manners.  Drains can't stay in forever so at some point, if you don't have less output, your surgeon will need to discuss options of pulling the drain, leaving it in, or converting to an open drain that is pulled an inch or so a day.

Russell Ashinoff, MD, FACS · Answer

Great question.I remove drains when they are less than 20ml more 2 days.  Follow the lead of your surgeon.  There isn't anything you can do to make less fluid, your body is recovering and makes fluid in the process.  Best wishes

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