Problems with Drain

I had a mastectomy r breast on December 10.  My drain was supposed to come out in a week.  It's still in and producing at least 60 cc per day.  I have always been on antibiotics.  I've gone back to work and resumed normal activities.  The draining just won't stop.  My surgeon tried injections of tetracycline but still draining.  It has slowed a little since the injections.  Any ideas?????????????????????????????????????????? I'm to the point that I want this drain out even if my breast starts swelling.  I know they can draw the fluid off if that happens.  HELP 

Sorry you're having problems - I'm sure you really do want to be getting on with your life about now.

The problems with so much draining is not that the breast might swell, but rather that having those tissues be so wet might reopen your incision line. While surgical incisions need moisture to heal, they can't be waterlogged or they won't heal. It's been long enough now that your incision should be healed completely, but the fact that it's still draining so much makes me wonder if there isn't something other than infection that has kept it from healing.

Has the dr cultured the drainage to see if there really is infection there?  If not, he should.  Has your dr done any scans of the site to find out what might be going on other than possible infection?  If not, he probably should do that too. 

You might consider getting a second opinion - find another doc who is willing to investigate why this is still draining. It can be really difficult to find someone to look at it - drs don't like to interfere with other drs surgical patients, but I would really push to find someone who is at least willing to take a look at it.  You might also push your insurance company to get you in to see another doc - tell them that the situation right now is doing nothing but cost them more money in the long run, especially if you have to end up having more surgery, when a little bit more attention to this now might prevent it.

I hope you can get some answers soon.  Just be real careful about insisting that they just close it up - you really don't want to be dealing with an open incision.

Sincerely,

Tre

Thanks for the response and the good ideas.  The first surgery I had was the mastectomy in November.  That drain came out in a week and my breast really swelled.  They did not get clear margins.  On Dec 10 went back in just to take tissue.  There was a large seroma and yes they did alot of cultures on it.  Was told everything was fine.  The surgeon says this fluid is lymph fluid and that one of the nodes is not closing off.  I haven't questioned that idea but maybe I should.  I have an oncological surgeon as well who admits this is a long time but doesn't seem to be that worried.  I probably do need to call another surgeon  I think the scan idea sounds reasonable and will ask for this tomorrow.  Other than this everything seems good.  My incisions healed really fast.  I don't feel sick, don't have a fever, etc.  Hope I can get another surgical consult in less that 6 weeks.  Thanks again.

Forgot to mention the tissue expander and two fills.  The expander hurts daily.  I wonder if maybe some people are not good candidates for these things and that maybe this is irritating something.

If there is no infection, then you certainly don't need any more antibiotics - that might just make things worse. It sounds reasonable that this could be a lymph node that isn't closing off.  That in itself would not be worrisome - with breast conservation and reconstruction they do expect lymph drainage to fill in the surgical area, except this seems to be a long time that it hasn't been able to heal itself. Possibly  may need to be PET or CT or ultrasound scanned to make sure the tissue is viable, and then stitched up. 

Yes, there are women who don't do well at all with the expanders - some people's bodies just don't like foreign objects. It may also be that the expander is putting too much pressure on a delicate part of the remaining lymph system that was already stressed by surgery and treatment.

Some docs are content to let something like this run its course - even if it takes many, many months.  I have some problems with that idea - the longer a person has an artificial opening into their body, the greater the chance of both acute and chronic infection, so I am glad you are considering a second opinion.  I also hope it won't take you too long to see another surgeon.

Hang in there, and keep pushing to get this resolved.

Sincerely,

Tre

I've asked for a scan and the surgeon declines this idea.  We are taking the drain out today.  Previously my breast became very swollen when the first drain was taken out but this was not painful.  I suppose they were able to remove alot of that fluid during the second surgery.  My only real fear at this point is lymphedema.  The nurse reports this is unlikely because the fluid is probably encapsulated but I wonder if it will go to my arm.  Is that likely??  I will probably get the implant within the next month or so.  What a world :)

I'm back again.  They removed the drain.  It will be two weeks on Wednesday.  My breast has started to swell more in the last 3 days.  Sore but not awful.  They are planning to put the implant in soon and calling this problem a seroma.  They say it is not lymphedema.  What is the difference really??? 

This article does a pretty good job of explaining what a seroma is:

http://en.wikipedia.org/wiki/Seroma

Seromas ususally consist of the plasma part of blood, whereas lymphedema is actually lymph fluid - not part of the blood at all. While a seroma actually forms a pocket of fluid that will push tissues aside, lymphedema is spread throughout skin, muscle and fat cells of a certain region.  Lymph is  a different kind of fluid, often containing bacteria, cellular debris and toxins that the lymph system is trying to filter out of the body.  That's why lymphedema can be such a serious problem - it's very easy to get infected through an open wound in an extremity or body part that is affected by lymphedema. 

The fluid in a seroma will usually reabsorb into tissues over time - and yes, sometimes it takes quite a while for this to happen.  Lymph fluid does not reabsorb into tissues.  It is meant to drain into lymph nodes, and the wastes it carries are then taken to the kidneys and bowel and excreted from the body. When the lymph nodes are gone, lymph fluid can only be drained naturally by gravity or the massaging action of muscles. That's kind of a catch-22, as too much muscle activity can increase flow of lymph fluid TO an area that is already bogged down by lymph fluid it can't get rid of.

Some drs will recommend low-level heat to help a seroma reabsorb.  Heat is actually contraindicated for lymphedema, unless it is accompanied by gravity drainage or active massage, and even then caution must be used because tissue that is overwhelmed with lymphedema can actually be damaged by too much heat.

Coping with a seroma definitely is not fun, but in terms of bodily risk, seromas are temporary situations that in most cases resolve without problems.  Lymphedema is a lifelong condition that if left untreated can have some very serious sequellae.

I hope things start going better for you now that the drain is out. Be patient, but remember to keep a close eye on any drainage that you may still be having. If you notice a change in color or a worsening of odor, start to have severe pain or start to run a fever, be sure to let your dr know. 

Sincerely,

Tre