Is a Drain for Lumpectomy + SLNB always necesary?

sportsee

My surgeon said there's no two ways about it - I will receive a drain after lumpetcomy + Sentinel Lymph Node Biopsy (SLNB). At first I didn't think anything of it, but many of the posts I've been reading since then are from women who didn't need a drain.

Has anyone else been told they definitely will have a drain in place after Lumpectomy + SLNB? Or know why a drain would be necessary? I'd like to ask my surgeon for a different approach to this if there's a better way. Thanks!

labelle

I did not have a drain for either my lumpectomy or SLNB incision. I suspect each surgeon has his or her own way of doing things and if you stick w this surgeon you will have a drain.

sportsee

Thanks @labelle! I suspect you're right, but I really like my surgeon so I was hoping it might just be a matter of knowing the magic words to ask for a different kind of procedure - something a little more informed-sounding than "I heard about a non-drain version of this surgery - can I get that?" which is probably what I'll just end up saying because I don't know how else to describe it Thanks!

Tinyfrog

Do you mind if I ask why you're against a drain? And why you think not having a drain is a better approach? You wrote, "many of the posts I've been reading since then are from women who didn't need a drain." Have you heard from women who needed a drain, but didn't have one?

Go to the blog hellobeautiful.org and select lymph node seroma to see what can happen. I am not allowed to post the link.

I had SLNB on Jan 3 and got a very painful seroma, not quite as big as the one in the blog link, but I made an emergency appointment Jan 13 with the surgeon and she luckily aspirated the fluid for me, which provided immediate relief. It hurt so badly, I was taking painkillers for it.

sportsee

Thanks @Tinyfrog! I'm not against a drain in theory, but once I saw that many people didn't have one, I questioned whether it was necessary. If my surgeon can clarify it for me and tell me it's being used to prevent seromas (and that that's something I'm likely to get with a sentinel lymph node biopsy), then I will understand it better. Basically, I just want to know more about this - to be more informed about the pros and cons.

Thanks for sharing the link - and your experience!

Tinyfrog

I guess it's hard to predict, who will get a seroma and how badly it can get. I read that seroma's can last for weeks, months, and even up to a year before they're reabsorbed into the body. - and some never go away. I also read that aspirating it has a small chance of introducing bacteria, later causing infection. Mine was smaller, but I can't even tell you how happy I was to have it drained, even knowing about the risk of infection. I had a 9cm phyllodes tumor removed Dec 13 (covered almost my entire breast), and then had to have the SLNB 3 weeks later, when they found multifocal IDC inside it (really rare) - so I've had 4.5 weeks of recovery from back to back surgeries. I would say the SLNB (only removed 2 nodes) was so much worse because I was sick afterwards, and the seroma alone, because it's in a peculiar place under the armpit, and you can't put your arm down, and you rub against it if you try to walk.

In my opinion, if you're having all of it done in one surgery, perhaps putting up with a drain once is a compromise. Although, since I didn't have a drain I can't tell you what that is like. I read that seromas usually show up 7-10 days after surgery, which is exactly when mine did. But can also come up weeks later, and after the drain is taken out (even if you have one).

I apologize my initial and first post ever on the site (to you) came out too direct and not so nice. I didn't mean it to, but you are very pleasant. I think you should have that conversation that you mentioned with your surgeon, as you serve to know why from him. Please don't let me interfere with that.

Tinyfrog

Hopefully someone can tell you what a drain is like?

ElaineTherese

Hmm, I had a lumpectomy + axillary lymph node dissection, and I had a drain. I figured it was because I was having all of my Levels 1 and 2 lymph nodes removed, but who knows. By the way, having a drain did not prevent a seroma from forming. I had to have my seroma drained before my radiation oncologist would work with me. Oh well.

I also wonder if I ended up with a drain because of the location of my lump (?). I have no idea. After five months of chemo, I was just happy to be having my surgery already and I didn't ask many questions.

Best wishes!

Spookiesmom

I had 4 after bmx. Draining them was a PITA, but not painful. Showers, I just tied them together and carried on. Sleeping wasn't a problem, the first night home in recliner then bed. 3 didn't hurt at all when they were removed, the last one did.

No big deal for me. Hope the same for you.

Alli

I did have a drain after my lumpectomy and SLNB (this was 10 yrs ago). My tumor was in the very upper outer portion of my breast near my armpit and very close to the sentinel node removal site. I'm not sure if it was because of location or not. It may very well just vary based upon the surgeon's preference and training. The drains are very manageable but just a nuisance.

I hade a BMX on 1/6/17 and had those drains removed 6 days later. I believe I have overdone it this weekend and may be developing a seroma, Wish I hadn't pushed so hard to get them removed.

Good luck to you

sportsee

Thanks @Tinyfrog @ElaineTherese @Spookiesmom and @Alli ! It helps a great deal to hear your stories as it puts my mind more at ease to have a better understanding of what this experience will be like.

I was also assuming the drain was a fail-safe against a seroma so I'm glad it was pointed out that it's not - because even though that's not what I wanted to hear, I still feel better knowing - more prepared. Thanks!

sportsee

@TinyFrog also, no worries! I thought your first comment was good - a very fair question that helped me clarify my own thinking on why I was asking about this. Thanks again for your considerate and thoughtful responses!

Tinyfrog

Hi again sportsee. When I was 16 I had a moped accident and was in the hospital for a week. I didn't realize until now, that I had a drain in my leg for the entire stay in the hospital. It didn't really matter if it was there or not because I was lying in a hospital bed that whole time. I don't know how other people healed or what their responsibilities are, but I would say after both of my surgeries, I was pretty much in bed for the first 4 days and then some, taking the percocet as prescribed, which makes you sleepy. I couldn't really do very much except give it time to heal, so if I had a drain, I don't think it would have gotten in the way of things much for the first week. Aside from getting the seroma drained by aspiration for the pain, the weather was going to be somewhat decent and I wanted to be able to walk outside, and I don't think I could do that with the friction from arm movements if the seroma was still there. I also had to sleep with my arm out to avoid putting pressure on the bump. I wonder if you just carry the drain with you or put it in your pocket?

sportsee

Oof. Sounds like a rough moped accident!

I get the impression it can be carried with you. Of course, with my luck I'll end up tripping or bumping it into a wall in the middle of the night

Freya244117

I was given a fabric shoulder bag to carry my drains in before I left hospital. I went shopping on my way home and the drains were totally obscured. When I slept at night I opened the top drawer of my bedside table and popped them in there. There was enough tubing that I could roll over without worry of pulling them out. It wasn't until they were being removed that I realised how much tubing was inside me. They were held in place with a few stitches so very secure, and the removal process was painless.

sportsee

Thanks Freya! I'm glad it felt secure and you didn't have to worry about accidentally pulling them out - that thought has crossed my mind a few (or more) times Thanks!

tgtg

Sportsee--I had an lx and no drain. The surgeon mentioned the possibility that I might wake up to find a drain, but his heads-up never materialized. From the variety of responses you have received, I suspect that the drain/no drain decision is based on factors like tumor size, the location of the tumor, the amount of tissue needed to be taken to ensure clean margins, and how many lymph nodes are removed, (My 1.6 cm tumor, for instance, was at 11 o'clock, 5 cm above the nipple--i.e., pretty accessible all around--and the surgeon only needed to take one node, which was clean--thus, no drain needed). You might want to ask your surgeon why s/he says you will have a drain--and if you don't like the answer, then get a second opinion.

sportsee

Thanks TGTG - I'm looking forward to my surgeon's office being open tomorrow so I can ask this question. I'm also glad you mentioned the location of your tumor. Mine is also at 11 o'clock, although slightly larger at 2 cm. I'm hopeful it may be a game day decision if they can keep the margins low. Just one less thing to worry about in recovery.

Hopeful82014

I had lumpectomy and sentinel node biopsy.

Initially, I was told full lymph node dissection would be scheduled and that it would require drains. With the change to a simple SLNB I was told drains would not be required. I think it's MUCH more common for surgeons to do SLNB and lx w/out drains. FWIW, the tumor was also upper, outer quadrant and my sentinel nodes were scattered throughout levels I, II and III.

Drains aren't the end of the world but they are a nuisance and can be uncomfortable.

sportsee

Thanks Hopeful82104!

Tinyfrog

Sportsee, you are already on hormone therapy prior to surgery? And also got you entire diagnosis before surgery, too? How did that happen? They can tell all of that from the biopsy?

Hmm. I am ER+ 96%, but I won't be put on hormone therapy until after chemo and radiation - in like 6-8 months. Since I'm so strongly ER+, I am assuming 96% is high, then perhaps I should ask about doing hormone therapy earlier, too? If I am 46, doesn't estradiol start to raise really high before menopause (probably around 51)?

Anyone know what kind of thought goes into the order of chemo, radiation, and hormone therapy? I see my oncologist on Wed, so I can ask her, but your thoughts are welcome.

BTW, my phylloddes started in upper outer quadrant, but was more like from 7-12 0'clock (it was smaller at the surgery because I started my cycle - covered entire breast at the end of luteal phase). So there was a big pocket of tissue effected, but luckily the tissue came together and healed well after surgery. There seemed to be more trauma from the SNB. I also read that a drain, when placed well, can facilitate healing and help to bring the tissues together faster. But a poorly placed drain can increase infection.

Yeah, I ran into a guard rail with the moped, and cut my leg open. It ended my track career my sophomore year. My junior year I started filling out more and partying.

sportsee

Hi Tinyfrog, Yes, all of the information I've shared was from my core needle biopsy - and yes, I've started Tamoxifen before surgery.

Here's what happened - once I received the biopsy report I called the American Cancer Society help line and learned that Tamoxifen is effective against my type of tumor (my ER+ score is 5/5 and 3/3 according to the pathology report). I also learned that Tamoxifen is sometimes even prescribed as a preventative therapy (to prevent further metastases and occurrences in the other breast).

Later, when I met with my surgeon I asked her whether it could hurt to start on Tamoxifen before surgery - and why wait? The fact that Tamoxifen has been around for more than 30 years and is used preventatively gave me a high degree of comfort with the idea of starting it right away.

She said we could start right away but pointed out that if I start Tamoxifen before surgery and then later request an Oncotype test, they will need to use a tumor sample from my biopsy rather than a sample from my lumpectomy, as the Tamoxifen will have affected the lumpectomy sample and can skew results of the oncotype test. Since it makes no difference to me what sample they want to pull from for the Oncotype test, I was happy to just get it going.

Of course, everyones situation is different and there could be other factors at play as well, but it seems to me like it can never hurt to ask about different approaches - and certainly, as patients, we all deserve a thorough explanation of any treatment recommendation.

I truly admire and respect my surgeon -she's incredibly smart and capable and wonderful - but this doesn't stop me from trying to gather as many different opinions and perspectives as possible. Fortunately, I think she knows how much I respect her views and doesn't take offense at my need to look at things from multiple angles as part off my personal learning process.

Tresjoli2

I had a huge incision and a large amount of tissue removed during my lumpectomy and no drain. I did have a seroma...I "sloshed" for a couple months, but the fluid reabsorbed.

Tinyfrog

Thanks sportsee for taking the time to share all of that. Yes, I am going to ask my oncologist when I see her in two days about the order of treatment. I remember when I met with her last week and she told me that I was going to be put on hormone treatment last, that it seemed a bit odd since that was the one thing we knew for sure, that I was ER+, and why don't we start with that. At the time I kept coming up HER2 equivocal, and if that wasn't as strong a driver for the tumor, why deal with that right away. I don't know, maybe they have a reason for not doing chemo and tamoxifen at the same time?

Tinyfrog

I just did a quick search and just on this site it says:

The study also showed that starting hormonal therapy after chemotherapy was done was better than giving hormonal therapy and chemotherapy at the same time. Women who got tamoxifen after chemotherapy was done were 16% less likely to have a recurrence compared to women who got tamoxifen at the same time as chemotherapy. This difference also wasn't statistically significant, which means it could have been due to chance and not because of the difference in treatment.

I'm still looking for more research.

Spookiesmom

Depending on the chemo, some ladies get through it fairly well. Others, like me, had a hard time. I couldn't imagine trying to cope with chemo and tamoxifen or the arimadex at the same time. Shoot me now.

There's no harm in waiting, and you may want to. I did chemo, surgery, rads, then AI.

Meow13

I am not sure there is no harm in waiting. I am glad to have chosen no chemo and get on AI treatment as soon as possible. Maybe in the future the technology will exist to tell if a treatment is working.

As far as chemo and hormone treatment at the same time may be working at cross purposes.

sportsee

I think you're on the right track in terms of doing research and asking more questions- that's at least one thing that can't hurt @Tinyfrog

Tinyfrog

Ha! Ha! - Spookiesmom is so funny. Yes, that crossed my mind - trying to do both chemo and hormone therapy could be mighty painful.

Meow13 - What?!? There is no test to see if a treatment is working? I thought there was. Are the blood markers used for this?

Sportsee - I also read on a UK site that hormone therapy can be used (similarly like chemo is) to shrink a tumor before surgery. It will be interesting to see the size after pathology. I told my BC surgeon that my tumor was almost twice the size, covering my entire breast towards the end of my luteal phase (before period). She didn't really believe me, although they have pubmed clinical studies on it. My surgery date ended up being on the 5th day of my cycle, which I was happy about since I knew it would be smaller, Surgeon said didn't schedule around people's menstrual cycles. I think it would be worth considering when your tumor is 9cm on a small day, and twice that on a different day - it would mean way different incisions and margins.

Meow13

Tumor markers elevaring may be an indication of recurrence. But I asked my mo how do we know if these AI drugs are working he said we don't. However, if you have lesion or tumor and see it shirking in size then I would say the medication is working.

Tinyfrog

Meow13 - Really?!?! You can go through all of the trouble to take hormone therapy and not really know if it's doing it's job? Holy cow. I had no idea.

I took a 23andme test that said I might be a CYP2D6 slow metabolizer. Something like 25% of antidepressants and some painkillers are metabolized by the CYP2D6 enzyme, and I could overdose if given them. Tamoxifen is also metabolized by that enzyme, and if you have that gene defect, the tamoxifen wouldn't work, and you'd probably be suffering with no benefit - but I guess you wouldn't know that was happening - because no one gets a gene test (that can tell you what you're allergic to before you have to have a reaction to it to find out). They're building a world class cancer center in Northern VA, and when I mentioned this to my MO, she said they have a specialist who deals with just this type of testing.