A mastectomy is surgery to remove the entire breast. It’s one of the main treatments for breast cancer. Like most major surgeries, it comes with potential complications during recovery. One of the most common is dealing with surgical drains and drainage after mastectomy.
Mastectomies leave behind large surgical wounds that weep lymph fluid and blood after surgery. This drainage needs an outlet to leave the body and promote healing. That’s why surgeons place drainage tubes under the skin at the mastectomy site that stay in place for days or weeks after the operation.
These drains allow fluid buildup from the mastectomy to leave the body. But knowing if your drains are removing too much or too little fluid can be confusing. What amount of drainage after mastectomy is normal versus abnormal?
What Are Surgical Drains?
Surgical drains are thin plastic tubes that drain fluid from the mastectomy site. They provide an exit route for lymph fluid and blood that pools under the skin after surgery. The drains remain under the skin for a period of time as prescribed by the surgeon, typically around 1-3 weeks.
The drains emerge from small holes in the skin, often near the armpit or breast area. At the end is a plastic bulb where fluid collects. The bulb needs to be emptied periodically when full. This removes the fluid away from the body so it doesn’t accumulate under the skin.
Why Are Drains Necessary After Mastectomy?
Drains serve a vital purpose following mastectomy and other major breast surgeries. Here are some key reasons drains are left in place:
- Prevents fluid buildup under the skin – Fluid naturally accumulates at the surgery site. Without a drain, this can cause problematic swelling.
- Allows incisions to heal – Drainage keeps surgical incisions clean and dry by preventing blood and lymph fluid from collecting.
- Reduces risk of infection – Bacteria thrive in accumulations of fluid. Drains allow fluid to properly exit.
- Monitors postoperative bleeding – Sudden increases in bloody drainage can signal problematic bleeding under the skin.
- Avoid seromas – Seromas are pockets of clear fluid that can form at the mastectomy site without proper drainage.
While drains can be uncomfortable and inconvenient, they play an important role in recovery after mastectomy. Removing them too soon can impede proper healing of the surgical site.
What to Expect with Drainage After Mastectomy
The drainage from mastectomy drains can seem alarming, especially since the bulbs fill with 30mL fluid or more. But having significant drainage is normal and even desired.
Here’s what to expect:
- Peak drainage occurs 1-3 days after surgery.
- Drainage slows down around 5-7 days post-op.
- The drainage changes color from bloody to pinkish to yellow/clear.
- Average time drains remain in place is 10-14 days.
- Each drain typically removes 30-100 mL of fluid per day.
Track your drainage daily to identify any problematic changes. But in general, expect to empty each drain 1-3 times per day. The total daily output from both drains combined typically ranges from 60-150 mL.
Is My Drainage Normal?
Your surgeon will give you guidelines on “normal” drainage to expect. But you can use the following general table to determine if your drainage seems within normal limits versus unusually high or low:
| Days Post-Op | Normal Drainage Volume |
|---|---|
| 1-3 days | 60-150 mL per drain |
| 4-7 days | 30-100 mL per drain |
| Second week | 10-60 mL per drain |
Your healthcare team will monitor your drainage amounts and determine if the volume is appropriate for your particular mastectomy procedure and recovery stage.
When Is Drainage Too Much?
While up to 150 mL of drainage per day is normal early on, larger volumes could potentially signal problematic bleeding or fluid buildup. Contact your doctor if you have any of the following:
- Sudden large increase in drainage
- One drain producing 100+ mL more than the other per day
- Continued output of 150+ mL per drain per day past one week
- Thick bloody drainage that persists past the first week
You know your body best. Even if drainage amounts are within normal daily limits, call your provider if you have worsening pain, swelling, redness, warmth or any concerns about excessive fluid output.
When Is Drainage Too Little?
A decrease in drainage is expected and desired as you recover after mastectomy. But a sudden or premature drop in output could mean a drain is blocked or not working properly.
Notify your healthcare provider if you notice any of the following:
- Sudden decrease in drainage volume
- One drain has significantly less output than the other
- Thickening, clotting or change in color/consistency of fluid
- Hardening or swelling around drain site
Changing position, gently massaging the drain site, or taking a walk can sometimes help stimulate better drainage. But contact your care team if you notice persistently low output.
Steps to Manage Drains After Mastectomy
To properly care for your drains after mastectomy:
- Track output daily – Record drainage amounts from each drain.
- Empty drains when bulbs fill – Typically 1-3 times per day.
- Measure and discard drainage – Do not reuse or return drained fluid.
- Record color and consistency – Note if drainage changes.
- Clean skin and secure drains – Keep skin around drain sites clean and use gauze to gently secure drains.
- Avoid tension or pressure – Position drains so tubing does not pull.
- Notify provider of changes – Especially decreased or excess drainage.
Caring for drains properly helps promote healing after mastectomy. Always contact your care team with any questions or concerns.
When Are Drains Removed After Mastectomy?
Drains are typically left in place for 1-3 weeks after mastectomy, but your surgeon will advise you on the ideal timing. Drains can generally come out when:
- Drainage decreases to 20-30 mL per day.
- Drainage becomes lighter yellow or clear.
- Incisions have closed and appear to be healing well.
- Minimal hardness or fluid buildup remains at the surgery site.
Some doctors will remove drains sequentially over a couple weeks. Others take out both simultaneously when drainage is sufficiently low. Discuss drain removal timing with your surgical team.
Signs of Infection After Drain Removal
After drain removal, continue monitoring the surgery site for any signs of infection, including:
- Increasing pain, swelling or redness
- Warmth, soreness or tenderness
- Pus-like drainage
- Fever or chills
A small amount of continued drainage after drain removal is common and not necessarily a concern. But call your doctor if you notice increasing swelling, fluid buildup, or any other worrisome symptoms at the mastectomy site after drains come out.
Conclusion
Having drains after mastectomy can be an uncomfortable part of the recovery process. But they play an important role in allowing fluid drainage and helping incisions heal.
While drainage amounts may seem excessive, outputs of 60-150 mL per day are normal. Contact your care team if you have any sudden changes in drainage, especially a significant increase or decrease in output.
With proper care and tracking of your drains, complications are uncommon. Communicate any questions or concerns to your provider to ensure optimal recovery after your mastectomy.
