August 2014 Ask the Expert: Drains, Incisions and Wound Healing
Surgeries such as lumpectomy and mastectomy are a standard part of treatment for most people diagnosed with breast cancer. In lumpectomy, only the tumor and a small area of healthy tissue around it are removed. In mastectomy, the whole breast or both breasts are removed.
The surgeries use different incision methods, ways the surgeon cuts the skin. You may also need a drain after surgery to stop fluids from filling the empty space left when the tumor is taken out.
During the month of August, Living Beyond Breast Cancer experts Steve Martinez, MD, MAS, FACS and Tonia Goffinet, RN answered your questions about what kinds of incisions may be used during your surgery, when a drain may be needed and what to expect during the healing process.
Remember: we cannot provide diagnoses, medical consultations or specific treatment recommendations. This service is designed for educational and informational purposes only. The information is general in nature. For specific healthcare questions or concerns, consult your healthcare provider because treatment varies with individual circumstances. The content is not intended in any way to substitute for professional counseling or medical advice.
I had a modified radical mastectomy. My drain tube stopped up after my first night home and my whole left chest was swollen and leaking through my whole incision. To this day there are times the place where the drain tube was hurts and swells little. Why is it doing this even now?
My port (Power Port) was removed by my surgeon on May 27, 2014. The steri-strips took about 3 weeks to fall off. Sometimes I feel a sharp, but quick, pain. How long does it usually take a port removal incision to completely heal? Do others experience this discomfort as well?
Question: I was diagnosed in February 2011 with two kinds of cancer in my left breast: stage 2 invasive carcinoma and DCI, both high grade. I had a modified radical mastectomy. My drain tube stopped up after my first night home and my whole left chest was swollen and leaking through my whole incision. To this day there are times the place where the drain tube was hurts and swells little. I will rub it with my hand to get it to ease. Why is it doing this even now?
Dr. Martinez: These two questions really highlight something that is not talked about much regarding the surgical treatment of breast cancer: persistent pain. Data from a variety of sources indicate that persistent pain (longer than 3 months duration) after breast surgery can occur in nearly 50% of cases (1-4). A survey of over 3000 women who underwent breast surgery in Denmark indicated that, at an average of 26 months after surgery, 47% of women reported pain (5). Factors associated with persistent pain included young age and the use of radiation therapy. Persistent pain was more common in patients who had all of their lymph nodes removed (axillary node dissection) as opposed to a lymph node sampling (sentinel node biopsy).
Conservative measures can help, such as keeping active, exercising and using stretching/yoga to help relax. Warm or cold compresses may give symptomatic relief, as can non-steroidal anti-inflammatory drugs such as ibuprofen. Some women may have persistent discomfort as a result of lymphedema (swelling) that is affecting the breast, underarm area or upper arm. In these cases, physical therapy and lymphedema therapy may help provide much needed relief.
1. Perkins FM, Kehlet H. Chronic pain as an outcome of surgery. A review of predictive factors. Anesthesiology. 2000;93:1123–1133. [PubMed]
2. Andersen KG, Kehlet H. Persistent pain after breast cancer treatment: a critical review of risk factors and strategies for prevention. J Pain. 2011;12:725–746.
3. Vadivelu N, Schreck M, Lopez J, Kodumudi G, Narayan D. Pain after mastectomy and breast reconstruction. Am Surg. 2008;74:285–296.
4. Katz J, Poleshuck EL, Andrus CH, et al. Risk factors for acute pain and its persistence following breast cancer surgery. Pain. 2005;119:16–25.
5. Gartner R, Jensen MB, Nielsen J, et al. Prevalence of and factors associated with persistent pain following breast cancer surgery. JAMA. 2009;302:1985–1992.
Question: My port (Power Port) was removed by my surgeon on May 27, 2014. The steri-strips took about 3 weeks to fall off. It doesn't really hurt, but feels picky and annoying. Sometimes I feel a sharp, but quick, pain. How long does it usually take a port removal incision to completely heal? Do others experience this discomfort as well?
Dr. Martinez: In general, a surgical incision will be considered healed at full strength after 6 weeks. Sensory nerves that were cut in the soft tissues will take longer to regenerate and grow. The altered nerve pathways due to the surgery with scar formation can cause the symptoms you describe. Such sensations may take as long as 6 – 12 months to go away.
Dr. Martinez: It is your surgeon’s goal to remove the drain at the right time, but when is the right time? If it is removed too early, the surgery space will refill with fluid, which may increase the risk of discomfort, infection and poor wound healing. Furthermore, such fluid collections may delay other treatments such as radiation or chemotherapy. One of the best guides of when the drain can be removed is the amount of fluid output over a 24 hour period.
In my practice, I ask patients to come in to my office to have their drain removed if it has put out 30 ml of fluid per 24 hours or less, which means that they need to empty and record their drain output on a regular basis, usually at least twice daily.
Dr. Martinez: I think that it is very important to talk about the type of wound care that is expected with your surgeon, both before and after surgery. If you ask ten different surgeons, you may not get ten different answers, but you would certainly get more than one!
In general, I tend to close my breast incisions using a thin, absorbable suture material that is used underneath the skin, so that no stitches require removal after surgery. Rather than a dressing, I seal the wound with a surgical grade, waterproof “glue,” of which there are several commercially available. Use of these surgical adhesives allow patients to shower and frees them from the responsibility for dressing changes and wound care.
Dr. Martinez: In general, additional drains may be required if the surgical space is larger, or if there is more than one surgical site. For example, a large-breasted woman may be more likely to require 2 drains following a mastectomy than a small-breasted woman, because there is a larger space for fluid to collect. Similarly, if a woman has a mastectomy and an axillary lymph node dissection (removal of several underarm lymph nodes), it is common to leave one drain where the breast was, and another in the underarm where the lymph nodes were removed.