title: Should a drain be placed in early breast cancer surgery?
abstract: BACKGROUND
  The current surgical debate has led to a reduction in the extent of surgery performed and thereby to a reduced occurrence of surgical trauma and, over the recent years, reduced seroma formation. This reduction in surgical procedures calls the need for a drain into question.
  
  
  METHODS
  Using Google Scholar and the National Library of Medicine (PubMed), a literature review was performed on systematic reviews and meta-analyses regarding breast cancer surgery ± axillary dissection. Additionally, randomized trials for the time period after the last systematic review were included and evaluated according to the Jadad score.
  
  
  RESULTS
  The search returned 5 systematic reviews, in which a total of 1,075 patients were included (537 cases and 538 controls). Since the last review, no prospective randomized trial meeting the inclusion criteria has been published. The current reviews conclude that insertion of a drain is associated with a longer hospital stay and reduced seroma formation. The data regarding wound infection and drain insertion is inconclusive. The omission of a drain is associated with early discharge, reduced postsurgical pain, and early mobilization, but also with an increase in outpatient seroma aspirations.
  
  
  CONCLUSIONS
  The omission of a drain is possible in early breast cancer surgery (wide local excision and sentinel node biopsy) with adequate surgical techniques and instruments.
authors.affiliation: Universitätsfrauenklinik Ulm, Germany.
authors.forename: Florian
authors.initials: F
authors.lastname: Ebner
authors.affiliation: Universitätsfrauenklinik Ulm, Germany.
authors.forename: Niko
authors.initials: N
authors.lastname: deGregorio
authors.affiliation: Universitätsfrauenklinik Ulm, Germany.
authors.forename: Elena
authors.initials: E
authors.lastname: Vorwerk
authors.affiliation: Universitätsfrauenklinik Ulm, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Janni
authors.affiliation: Universitätsfrauenklinik Würzburg, Germany.
authors.forename: Achim
authors.initials: A
authors.lastname: Wöckel
authors.affiliation: Universitätsfrauenklinik Ulm, Germany.
authors.forename: Dominic
authors.initials: D
authors.lastname: Varga
keywords: Breast cancer; Breast conserving; Drain; Sentinel; Seroma; Surgery; Wound