Understanding the Purpose of Surgical Drains
After top surgery, the removal of breast tissue leaves a space where fluid can collect. This fluid can lead to complications such as a seroma (a buildup of clear fluid) or hematoma (a collection of blood). To prevent these issues, surgeons insert small, flexible tubes called drains, which draw the excess fluid out of the body and into a collection bulb. The use of drains is a standard procedure and is crucial for promoting proper healing and achieving the best possible surgical outcome. They typically remain in place for one to two weeks, or until the amount of fluid collected decreases to a specific level, as determined by your surgical team.
Step-by-Step Guide to Drain Care
Proper drain care is essential for a smooth recovery and involves a few key steps that will be demonstrated by your medical team before you are discharged.
How to Empty a Jackson-Pratt (JP) Drain
This is a common type of drain used after surgery, featuring a soft, compressible bulb. Emptying it is a simple process you will need to perform several times a day.
- Gather your supplies: You will need a measuring cup or container, a pen, and your drain output log sheet. A clean, designated space is also helpful.
- Wash your hands: Always wash your hands thoroughly with soap and water for at least 20 seconds before touching the drains.
- Open the bulb: Pinch the bulb firmly and pull the cap off the top, pointing the opening away from your face.
- Empty the fluid: Pour the collected fluid from the bulb into your measuring cup. Observe the fluid's color and consistency.
- Restore suction: Squeeze the bulb completely flat to remove all the air. While keeping it squeezed flat, quickly replace the cap to seal it. The bulb should stay compressed and flat, creating the vacuum needed for drainage.
- Record the data: Note the date, time, and amount of fluid emptied in cubic centimeters (cc) on your log sheet. Also, jot down the color of the drainage.
- Dispose and clean: Flush the fluid down the toilet and wash your hands again.
How to Strip the Drain Tubing
Sometimes, small clots can form in the drain tubing, blocking the flow of fluid. "Stripping" or "milking" the tube helps to clear these clots.
- Wash your hands with soap and water.
- Anchor the tube: Using one hand, firmly pinch the tubing close to where it exits your skin.
- Squeeze and pull: With your other hand, pinch the tube and slide your fingers down toward the collection bulb. This action pushes any clots toward the bulb.
- Repeat: Repeat the squeezing and pulling motion several times until the tubing is clear. You can use an alcohol swab or hand lotion to make your fingers slide more easily.
Managing Discomfort and Daily Activities
Living with drains can be awkward, but with some simple strategies, you can minimize discomfort and maintain a level of mobility.
Pain Management
- Use prescribed medication: Take your prescribed pain medication as directed by your surgeon. Staying ahead of the pain is more effective than waiting for it to become severe.
- Avoid certain medications: Do not take nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen unless approved by your doctor, as they can increase the risk of bleeding.
- Understand normal sensations: It is common to feel a pulling or stinging sensation around the drain sites. Most patients describe drain discomfort as manageable rather than intensely painful.
Clothing and Drain Security
- Wear loose-fitting clothing: Opt for soft, loose-fitting tops, such as button-down shirts, to avoid irritating the surgical area and allow for easier dressing.
- Use special garments: Consider purchasing a post-surgical camisole or shirt with internal drain pockets. These are designed to hold the bulbs securely and comfortably.
- Pinning the drains: If you don't have special garments, use safety pins to attach the bulbs to the inside of your clothes. This prevents them from dangling and pulling on the incision site.
Activity Levels
- Stay mobile: Light, leisurely walking is recommended to promote circulation and prevent blood clots. However, avoid strenuous activities or anything that significantly raises your heart rate and blood pressure.
- Protect drains while sleeping: Many surgeons recommend sleeping on your back, propped up with pillows. If you move a lot in your sleep, this can help prevent accidental tugging or pulling on the drains.
Normal Healing vs. Potential Complications
Monitoring your drains for changes is a key part of recovery. Here is a comparison of what to expect during normal healing versus potential signs of a problem.
| Symptom | Normal Healing | Potential Complication |
|---|---|---|
| Drainage Fluid | Decreases over time, changes from dark red to pink to clear/yellow. | Sudden increase, remains bright red, becomes thick/cloudy/foul-smelling. |
| Drain Site | Minimal tenderness, normal color, minimal leakage. | Increased redness, swelling, warmth, tenderness, or leakage around the site. |
| Pain | Manageable with medication, mild pulling/stinging sensations. | Sudden, sharp increase in pain not relieved by medication. |
| Drain Function | Maintains suction (bulb stays flat), drains consistently. | Loses suction (bulb stays inflated), tubing becomes clogged despite stripping, or fluid leaks around the insertion site. |
Drain Removal and Recovery Completion
The most anticipated part of having drains is their removal. Your surgeon will remove the drains during a follow-up appointment, typically when the daily fluid output has dropped to below 20-30cc for two consecutive days. The process is very quick, with many patients reporting a strange sensation of pulling or pressure, but not significant pain. After removal, the small incisions will be covered with a bandage and will heal quickly, leaving behind minimal scarring.
For more detailed information on surgical drain care and best practices, consult the resources provided by the American College of Surgeons.
Conclusion
Dealing with surgical drains is an essential, albeit temporary, part of the post-operative journey after top surgery. By following proper hygiene, monitoring fluid output, and understanding when to contact your healthcare provider, you can navigate this phase of recovery with confidence. These simple, consistent steps are key to preventing complications, promoting efficient healing, and ensuring the best possible results from your surgery.
