Is a Drain for Lumpectomy + SLNB always necesary?

ChiSandy

I had my lumpectomy (10:00, R upper outer quadrant) & SNB at a major teaching hospital with both a Breast Center of Excellence and a renowned cancer center. I did not have a drain. I did form both axillary & mammary seromas (the axillary one burst because the weight of my oversized breast was pulling it open, and it was expressed & sutured—it resorbed; the mammary one enlarged during radiation but has been slowly resorbing to smaller than it was before radiation). Whereas mastectomy and/or ALND almost always require drains, most lumpectomies with SNB don’t get them. In the latter instance, it’s probably a matter of the surgeon’s preference. Had I a drain it probably would have been in longer than usual and the seroma would have developed anyway. One of the questions my surgeon asked me at our first appointment was whether I have a tendency to develop blisters. I answered that I did—and since a seroma is basically a large internal blister, I’d likely have developed one, drain or no drain.

sportsee

Thanks ChiSandy

tapwhite

I had no drain for the excisional biopsy last month or my following SLNB over a week ago, HOWEVER I have already had to have my underarm drained yesterday & have to go back again tomorrow because the "goose egg" filled with fluid (seroma) is back, so I'm thinking a drain from the start might not be a bad idea! Good luck!

Anonymous

I didn't have one when I went home post-surgery...at first. After a few days, though, my breast swelled up so much that my surgeon did have to put in a drain. It freaked me out at first, but I quickly got used to it, and no one knew I had one. I went to bikram yoga with it in (tucked in the waistband of my yoga shorts) and also took my university students on a 3 mile hike with it (also tucked into my hiking shorts waistband). After 3 weeks (it took forever to drain) we took it out.

Claire in AZ

sportsee

Claire- Wow, I'm impressed you got back to yoga and hiking so quickly - and with the drain no less! I didn't realize it could be tucked away so discreetly - do you happen to recall the brand by any chance? Thanks!

Tinyfrog

Yoga and hiking - two of the things I would like to get back into. Although, not sure if I can do yoga with a port, as there are so many asanas that really stretch and open up the chest. Anyone know about yoga and ports?

Just an update - I had my SLB on Jan 3. I had the seroma aspirated on Jan 13 for pain. It refilled about 4 hours later that same evening, but not quite as large, and not as tender. A week later, it's still there, but again not tender.

Tinyfrog

Back to an earlier topic, I asked my MO about the order of treatment, and from what I recall she said that there was no indication of increased benefit from doing chemo at the same time as hormone therapy, and otherwise you're having to deal with many more side effects at the same time. As for doing chemo first, she said that it's a systemic treatment to catch any lose cancer cells roaming around first. While doing radiation first only focuses on cancer cells in the breast. However, she didn't explain why hormone therapy was done after radiation for me. I guess that also doesn't explain why you wouldn't do like hormone therapy alone first for a few months and then add in chemo. But in your case, if it's looking like you won't need chemo (HER2-, of course we're waiting on SNB)), then why not start hormone therapy as soon as possible.

sportsee

Tinyfrog - sounds like you at least got a better explanation on the order of treatments. Also you're right we're not looking at chemo for me yet, although never say never - I know things can change I hope your seroma continues to improve!

Tinyfrog

You are so funny - I hope your seroma continues to improve! Thanks! I keep up the rouse that I needed the seroma drained so I can start exercising. But I didn't exercise. I hope things do not change for you, and that you don't have to do chemo!

Tinyfrog

Sportsee! Did you have your surgery on Wed, 25th? When you feel better and if you feel like sharing, please let us know how it went (and if you got the drain). I had my port put in yesterday. It was awful, more painful I'd say than either of the previous surgeries. Luckily, I had some pain meds leftover to take.

sportsee

Hi Tinyfrog, thanks for checking in on me! I appreciate it. And I hope the discomfort you had with your port has subsided by now?

As for the drain, I didn't have one because I decided not to have any lymph nodes removed.

Yes, I know there's a risk in this, but I gave it a lot of thought, listened to a lot of opinions (including the strong opinions of my doctors) and read numerous articles backing up the standard of care which was SLNB in my case. However, I did encounter one person - a friend - who had a lumpectomy 20 years ago and no lymph nodes removed. And she has been cancer free for 20 years. So her story gave me hope that maybe - just maybe - I wasn't a complete lone nut for questioning this procedure. Plus, my husband ultimately came around to seeing it my way and has been fully supportive of my decision - and that helps tremendously.

In any case, long story short - now that the surgery is over, a week has passed and the margins came back clear, I feel good. It was the right decision for me for a variety of reasons, but primarily because there is no evidence of cancer in my lymph nodes. Yes, it's true that I can't know with 100% certainty that there aren't some microscopic cells floating around in my lymph nodes, but the trade off is that I get to keep all my lymph nodes... and personally - not saying this is for everyone - I'm good with that.

Now I'm just focusing on healing from surgery and taking it one day at a time