How Long Do Jackson Pratt Drains Stay in After Bilateral Mastectomy?

Question

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?

Stephen U. Harris, MD · Answer

Grammy Pammy,

	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

Thomas J. Lee, MD · Answer

Thank you for your question.  In general, I use drains after surgery that creates a large potential space, and mastectomy (and reconstruction) falls into that category.  After surgery, that space gets filled with fluid associated with healing.  Your body has the capacity to reabsorb some of it, however, if a lot of fluid is being produced it can create a collection that we call a seroma.  The drains prevent this by evacuating that extra fluid.  If the drains are taken out too quickly, there is a risk that the undrained fluid could become infected, which could require the expander to be removed.  The reconstruction process would then be delayed, since new expanders would not be able to be replaced for several months.  Every surgeon has their own criteria to take out drains, but in general I take them out when they are producing less than 30cc a day for at least two consecutive days.

How Long Do Jackson Pratt Drains Stay in After Bilateral Mastectomy?

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How Long Do Jackson Pratt Drains Stay in After Bilateral Mastectomy?

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