title: Breast cancer surgery without suction drainage: the impact of adopting a 'no drains' policy on symptomatic seroma formation rates.
abstract: OBJECTIVE
  To determine the effect of a 'no drains' policy on seroma formation and other complications in women undergoing breast cancer surgery.
  
  
  METHODS
  Before May 2010 drains were routinely used in our unit following mastectomy ± axillary surgery and axillary lymph node dissection (ALND) ± wide local excision (WLE). Since then, a 'no drains' policy has been adopted. Data was collected prospectively between 01/12/06 and 30/11/11 to compare symptomatic seroma, wound infection, re-admission and re-operation rates in women treated with a drain and those without.
  
  
  RESULTS
  596 women were included in the study. 247 women underwent modified radical mastectomy (MRM) and ALND (Group 1), 184 MRM ± sentinel lymph node biopsy (SLNB)/axillary node sampling (ANS) (Group 2) and 165 ALND ± WLE (Group 3). In group 1, 149 had a drain, in group 2, 62, and in group 3, 50. Within each group, the presence or absence of a drain did not significantly affect the rate of symptomatic seroma, number of aspirations performed, wound infection rates or the incidence of complications requiring re-admission. Having a drain was associated with lower volumes of seroma aspirated. In all three groups, the presence of a drain was associated with a longer hospital stay (p < 0.001).
  
  
  CONCLUSIONS
  This study suggests that MRM ± ALND/SLNB/ANS and ALND ± WLE can be performed without the use of suction drains without increasing seroma formation and other complication rates. Adopting a 'no-drains' policy may also contribute to earlier hospital discharge.
authors: Department of Breast Surgery, City Hospital, Sandwell and West Birmingham NHS Trust, Dudley Road, Birmingham B18 7QH, UK. jevan.taylor@nhs.net
authors: J C
authors: JC
authors: Taylor
authors: S
authors: S
authors: Rai
authors: F
authors: F
authors: Hoar
authors: H
authors: H
authors: Brown
authors: L
authors: L
authors: Vishwanath
mesh_terms: D001943:Breast Neoplasms / Q000601:surgery*; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D015994:Incidence; D007902:Length of Stay; D015411:Mastectomy, Modified Radical / Q000009:adverse effects / Q000379:methods*; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data; D011446:Prospective Studies; D012086:Reoperation / Q000706:statistics & numerical data; D049291:Seroma / Q000453:epidemiology* / Q000517:prevention & control; D013396:Suction; D013530:Surgical Wound Infection / Q000453:epidemiology; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology