December 15, 2014 - Drains, Buttons, and New Boobs. A trio of delight. (Warning: contains pictures)

A few of you were asking a while back for more details on the Breast Drains. Those awful little plastic pliable tubes that create nothing but misery for the beholder. There is no love. Nothing but a loathing that seems to be uniform for all those lucky enough to wake up from a surgical slumber to find them nesting in their breast. They serve a mighty purpose as they literally drain out accumulating fluid that would pool in the breast sack if the drains weren't present. They promote healing time and for some help reduce infection risk. So we have to argue that they are a tremendous addition to both the mastectomy and reconstruction surgical process, but despite their accolades from health care providers, we as retainers of such drains do hate them. Hate is not a word I utter very often, but I do not want you to miss my loathing. I hate drains.

My friend, Rachael, is undergoing reconstruction this month and she sent me some pictures of her drains and buttons (see below) for me to show you and was ok with me disclosing her name. I, in my journey, neglected to capture pictures for you of the drains. I think I must have subconsciously not wanted to give them celebrity status as done in a picture. I wanted them to feel neglected and inconsequential, but in that decision I wasn't able to visually prepare you if you find yourself at mastectomy’s door. She was so gracious to send me her pictures for educational reasons. You can see the drains below – long plastic tubes with bulky bulbs attached at the end. They start inside the breast, then at the exit site they are sutured into place to keep them from shifting around or completely falling out. The bulb has a “button” on the end, which is opened and closed a couple of times a day and emptied after recording the volume amount for the surgeon. Less drainage, better healing time, and the sooner you can pop those babies out! What you can’t see of the drain is inserted and coiled up inside the breast. At times you may have 2 drains (usually following mastectomy) and at times you may have 4 (usually following reconstruction).  If you hate drains like I do, your surgeon may refuse to tell you how many you will have when you wake up from reconstruction so you actually will show up for the procedure and you don’t dread it so much. Oh so kind. The cumbersome details of the drains is you have to “hook” them to your clothing. They are heavy and if they aren't hooked, you risk them dropping abruptly and yanking on the sutures where they are inserted into the breast. And that, folks, is a ton of fun. It’s like a day at the circus, but without all the cute performing animals, amazing acrobatic tricks, and fluffy pastel cotton candy. Ok, so it’s more like a dental procedure without anesthetic. Full disclosure, right? Just trust me, you want to do everything in your power to prevent that “yank” from occurring.

What you do and don’t want to do with drains, and I may or may not be speaking from personal experience (smile):

1. Do NOT clip them to your waist band. You risk heading to the bathroom, pulling your pants down, forgetting they were there and find that you have pulled on the suture stitch. You will know if you have done this because the scream can be heard all the way at the grocery store down the street.

2. Do NOT clip them to you shirt. You find you go to change shirts, forget they are clipped and find that you have pulled on the suture stitch. Again, You will know if you have done this because the scream can be heard all the way at the grocery store down the street. (However, the shirt is the better option than the pant if you have to choose.)

3. DO consider wearing a beautiful ribbon, tie it around your neck, and clip the drains to the ribbon. It’s fashionable and reduces the risk of tugging on the sutures. Also this ribbon can be hung in the shower, once your surgeon clears you of course, to hold your drains up out of the way. Obviously your pants and your shirt fail here.

4. Do NOT let your husband “milk” the drains trying to get every drop of fluid out of the drain line. He may want to do this is if he is a handy-man, or in some cases an engineer, as it is in his nature to have complete removal. This milking causes a suction pressure to develop within the breast and it will create another scream that can be heard around the world. Open the bulb head, empty drain into a measuring cup, record the volume, close the bulb, and then reattach the bulbs to ribbon. That’s all you need to do. No awards for the clean drain lines, my friend. Trust me, you can skip that and save you some not so pleasant experiences.

5. DO feel free to throw a basin at your husband should he accidentally forget to ever so gently lay the bulb on the table while he goes to empty the drainage in the sink. The first time is a freebie, the second you should at least yell “duck” before you hurl the basin in his direction.

6. DO consider cutting a “v” notch in the side of your sports bra.  This V allows the lines of the drain to slip out under your bra without having the tension of the sports bra’s bottom band pressing on the drain. Every bit of pressure on the drain pulls on the suture stitch more.

7. DO consider using some medical tape to “tape up” the drain so that you create some give around the insertion site and allows something between your insertion site and the accidental pull should it occur. The “pull” will be stopped by the tape instead of by the suture stitch.

8. Do NOT feel bad if you have a few tears because of the drains. They aren't comfortable. In fact they are downright uncomfortable. But you will get through it and they will be out in no time flat (you should expect several days up to a week or two depending on how soon your drainage lessens.)

9. And here is a freebie that I observed in Rachael’s pictures. DO wear a tube top! It’s brilliant in that it is so much easier not to have to navigate sleeves when you are restricted to not being able to raise your arms up above your head. Brilliant! And now I wish I had figured that one out for myself as I picture those nights Ron, my mom, and I were fighting the wardrobe issues at the end of an exhausting day.

On to the “buttons" seen in the picture below. I did not have this procedure done but wanted you to have this information should you need it. Buttons are used to hold grafted skin in place. Sometimes during mastectomy, so much (hopefully all) of the breast tissue is removed that you find the area under the skin becomes super thin. When that happens, the surgeon will take donor skin and attach it to your skin to provide extra thickness. The skin graft is held in place by buttons while the donor skin incorporates itself into your skin. Once that happens, the buttons can be removed.

Bruising. You can see her sides are significantly bruised. And you may recall seeing bruising in my pictures from last April following my lipografting surgery. This happens when fat is suctioned from one area on your body and then inserted into the breast as part of reconstruction. For those women who are candidates, this reconstruction of the entire new breast using your own fat results in a breast that feel and possibly looks more natural. It’s a bear of a procedure though with extensive recovery times from what I hear. For others, like myself, when an implant is used the relocated fat serves as a barrier between the implant itself and the breast skin when thinning and rippling of the implant occurs over time. My radiation exposure history prevented me from being a candidate for the more natural procedure and thus limited me to the use of implants. I don’t know which procedure is more preferable, but I know more and more women are choosing to avoid implants if possible.

Ok, so there you have completed your semester in Impostor Reconstruction 101. This information will be covered on your midterm exams. Study up! Extra points to Rachael for sharing her pictures with us so we could give you a mental picture if the process. Be praying for her as she is right in the middle of her journey as a breast cancer survivor and balancing life as a wife and mother of young kids. She's an advocate for women navigating breast cancer and is a champ in this process!

You can check back later in the week and we may have more pictures posted.

(Note: The thoughts expressed on this page are my own, so blame me alone if you take issue with anything above. I do know she shares our loathing of drains, but don’t want to misrepresent her.)


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