Breast cancer surgery without suction drainage: The impact of adopting a 'no drains' policy on symptomatic seroma formation rates

Aim: To determine the effect of a 'no drains' policy on seroma formation and other complications in women undergoing breast cancer surgery. Materials and 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). Conclusion: 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. (C) 2013 Published by Elsevier Ltd.