A mastectomy is a surgical procedure to remove the entire breast. Following the operation, surgeons place small, flexible surgical drains into the surgical site. The body naturally produces excess fluid, and the drain uses gentle suction to remove this fluid. This prevents accumulation under the skin, which could form a painful collection known as a seroma and interfere with healing.
Typical Drainage Volume and Timeline
In the immediate post-operative period, the volume of fluid collected is generally at its highest, sometimes measuring 100 to 150 milliliters (mL) over a 24-hour period. This initial high output is normal and is expected to decrease steadily as the body begins to heal the internal surgical space. Surgeons closely monitor the daily output because the amount of drainage is the primary factor determining when the tubes can be safely removed.
Drain removal usually takes between one and three weeks following the surgery. The surgical team provides a drainage log, requesting that the patient or caregiver record the total volume collected every 24 hours. The drain is ready for removal when the output has consistently dropped to a low threshold, commonly between 20 and 50 mL per 24 hours for two consecutive days.
Tapering volume indicates the body has largely closed the internal space and is ready to reabsorb the remaining fluid. While the average duration is around 7 to 14 days, drains are not left in place longer than three weeks due to an increasing risk of infection. The final decision on removal time is based on the specific, measured output of each drain.
Monitoring Fluid Consistency and Color
The appearance of the drainage fluid changes naturally as the wound heals. Immediately after surgery, the fluid is often dark red and thick, referred to as sanguineous drainage. This means it contains a significant amount of blood and is an expected result of the surgical process.
Over the next few days, the color should lighten, transitioning to a pink or reddish-pink hue, known as serosanguineous fluid, which is a mix of old blood and serous fluid. This change is a positive sign that the initial bleeding has subsided and the body is moving into the later stages of the healing process.
The fluid eventually becomes clear, pale yellow, or straw-colored, classified as serous fluid. This thin, watery fluid is primarily lymph and tissue fluid, and its appearance signals that the surgical site is almost completely healed internally. If the fluid suddenly becomes bright red again, it might indicate new bleeding that should be reported to the surgical team.
Practical Drain Care and Measurement
Managing the drains at home requires ensuring the system maintains suction and remains sterile. Before touching the drain or dressing, wash your hands thoroughly with soap and water to minimize bacteria introduction. The drain bulb must be emptied when it is approximately half to two-thirds full to maintain effective suction.
To empty the bulb, remove the plug and pour the fluid into a designated measuring cup. After emptying, the bulb must be manually squeezed flat to expel all the air. The plug is then immediately secured while maintaining compression. This action re-establishes the vacuum necessary for the drain to continue pulling fluid from the surgical site.
“Stripping” or “milking” the tubing several times a day prevents blockages. This technique involves pinching the tube near the insertion site with one hand. Use the thumb and forefinger of the other hand to slide down the tubing toward the bulb. This action pushes any forming clots or thick fluid into the collection bulb, ensuring continuous drainage flow.
Accurate measurement and logging of the fluid output is a required part of home care. The volume and time of each emptying must be recorded on a provided log sheet. If multiple drains are present, the output from each must be measured and recorded separately. Providing the surgical team with a precise 24-hour total allows them to track healing progress and determine the appropriate time for drain removal.
Indicators for Contacting the Surgical Team
While most changes in drainage volume and color are part of a normal healing pattern, certain signs may indicate a complication requiring professional attention. A sudden, significant increase in drainage volume, especially if the fluid is bright red, may signal new bleeding at the surgical site. This change should be reported to the surgeon immediately.
A sudden and complete cessation of drainage is also concerning if the bulb is maintaining suction. This suggests the tube is blocked by a clot, potentially leading to fluid buildup under the skin. Signs of infection at the insertion site, such as increasing redness, warmth, swelling, or pain, also warrant a call to the care team.
Changes in the fluid’s quality, such as becoming thick, cloudy, or developing a foul odor, can indicate infection. If the drain accidentally falls out or becomes partially dislodged, contact the surgical team for specific instructions, as this is a potential pathway for bacteria.