Single Versus Double Drainage Insertion After Total Mastectomy and Axillary Dissection

Main Article Content

Tin mg Win
Sie thu Myint
Aung Myat
Htun Thuya
Thein Lwin


Breast cancer, mastectomy, axillary dissection, seroma


Background: Breast cancer is the commonest malignancy in women of Myanmar. Mastectomy is one of the main surgical treatments of breast cancer. Postoperative seroma is a common complication after mastectomy, which increases chances of infection, delays wound healing, causes flap necrosis, persistent pain, and dehiscence of the wound and thus increases the convalescence period. This study aimed to compare the seroma formation between single drainage and double drainage after total mastectomy and axillary dissection for breast cancer patients.
Methods: One-year hospital based comparative study was conducted at general surgical wards of Yangon General Hospital where 150 patients were included. Patients were randomized into two groups: 75 patients were with single drain into axilla and another 75 patients were with double drains (one into axilla and one into mastectomy bed). Drainage volume was recorded daily and summed up into total amount. The drain was removed when output was <30ml in 24 hours for two consecutive days. Follow-up visits were made at second, third and fourth weeks to check for seroma.
Results: Mean age was 48.66 years in the single drain group and 51.22 years in the double drain group. Mean Body Mass Index (BMI) were 28.20kg/m2 in the first group and 28.79kg/m2 in the second. Statistically significant differences were not seen between the groups regarding total drain amount (315.13ml and 325.47ml, P=0.38). Duration of drains in the single group remained significantly shorter than in the double group (5.78 days and 6.38 days, P=0.002). Seroma during immediate postoperative period was seen in 29.3% and 36%, respectively (P=0.38). For one month follow-up, seroma was developed in 3 patients (4%) from each group. Statistically significant differences were not observed regarding the number of aspiration and the amount of aspiration between the two groups (P>0.05).
Conclusion: Both single and double drain methods had almost similar rates of seroma formation after total mastectomy and axillary dissection. But single drain is recommended to reduce patients’ discomfort with less morbidity and cost.


1. Bailey and Love’s Short Practice of Surgery; 27th Edition, 2018; pp 871-882.
2. Annual Statistical Report (2017). Yangon General Hospital. doi: not available
3. Ebrahimifard F. Effect of One versus Two Drain Insertion on Postoperative Seroma Formation after Modified Radical Mastectomy. Novel Biomed. 2016;4(2):45-50. doi: 10.22037/nbm.v4i2.7884.
4. Aitken DR, Milton JP. Complications associated with mastectomy. Surg North Am. 1983;63:1331-1352. doi: Not Available.
5. Pogson CJ, Adwani A, Ebbs SR. Seroma following breast cancer surgery. European Journal of Surgical Oncology. 2003; 29, 711-717. doi: 10.1016/S0748-7983(03)00096-9.
6. Sampathraju S, Rodrigues,G. Seroma formation after mastectomy: Pathogenesis and Prevention. Indian Journal of Surgical Oncology. 2010, 1(4), 328-333. doi: 10.1007/s13193-011-0067-5.
7. Puttawibul P, Sangthong B, Maipang T, et al. Mastectomy without drain at pectoral area: a randomized controlled trial. J Med Assoc Thai 2003; 86:325-31. Doi: Not Available.
8. Terrell GS, Singer JA. Axillary versus combined axillary and pectoral drainage after modified radical mastectomy. Surg Gynecol Obstet 1992; 175:437-40. doi: Not Available.
9. Zielinski J, Jaworski R, Irga N, Kruszewski JW, Jaskiewicz J. Analysis of selected factors influencing seroma formation in breast cancer patients undergoing mastectomy. Arch. Med. Sci. 2013; 9: 86–92. doi: 10.5114/aoms.2012.29219.
10. Burak W, Goodman P, Young D. Seroma formation following axillary Dissection for breast cancer: risk factors and lack of influence of bovine thrombin. J Surg Oncol. 1997;64:27-31. doi: 10.1002/(SICI)1096-9098(199701)64:1<27::AID-JSO6>3.0.CO;2-R.
11. Petrek JA, Peters MM, Cirrincione C, et al. A prospective randomized trial of single versus multiple drains in the axilla after lymphadenectomy. Surg Gynecol Obstet 1992; 175:405-9. doi: Not Available.
12. Agrawal A, Ayantunde AA, Cheung KL. Concepts of seroma formation and prevention in breast cancer surgery. ANZ J Surg 2006; 76:1088-95. doi: 10.1111/j.1445-2197.2006.03949.x.
13. Sùrensen LT, Hùrby J, Friis E, Pilsgaard B and Jùrgensen T. Smoking as a risk factor for wound healing and infection in breast cancer surgery EJSO 2002; 28: 815±820. doi : 10.1053/ejso.2002.1308.
14. Saratzis A, Soumian S, Willetts R, Stonelake PS, Rastall S. Use of Multiple Drains After Mastectomy Is Associated With More Patient Discomfort and Longer Postoperative Stay. Clinical Breast Cancer, 2009 ; 9 (4), 243-246. doi : 10.3816/CBC.2009.n.041.
15. Flap anchoring following primary breast cancer surgery facilitates early hospital discharge and reduces costs. Almond LM, Khodaverdi L, Kumar B, Coveney EC. Breast Care (Basel) 2010;5:97–101. doi: 10.1159/000301586.
16. The satisfaction and savings of early discharge with drain in situ following axillary lymphadenectomy in the treatment of breast cancer. Holcombe C, West N, Mansel RE, Horgan K. Eur J Surg Oncol. 1995;21:604–606. doi: 10.1016/S0748-7983(95)95133-4.
17. Early discharge with drain in situ following axillary lymphadenectomy for breast cancer. Horgan K, Benson EA, Miller A, Robertson A. Breast. 2000;9:90–92. DOI: 10.1054/brst.2000.0142
18. Purushotham A.D, Mclatchie E, Young D et al. Randomized clinical trial of no wound drains and early discharge in the treatment of women with breast cancer. Br. J. Surg 2002; 89: 286-292. doi: 10.1046/j.0007-1323.2001.02031.x.
19. Jain P.K, Sowdi R, Anderson A.D, Macfie J. Randomized clinical trial investigating the use of drains and fibrin sealant following surgery for breast cancer. Br J Surg 2004; 91: 54-60. doi: 10.1002/bjs.4435.
20. Sakkary MA. The value of mastectomy flap fixation in reducing fluid drainage and seroma formation in breast cancer patients. World J Surg Oncol 2012; 10:8. doi: 10.1186/1477-7819-10-8.
21. Yuhui Wu, Shouman Wang, Jian Hai, Jie Mao, Xue Dong and Zhi Xiao. Quilting suture is better than conventional suture with drain in preventing seroma formation at pectoral area after mastectomy BMC Surgery (2020) 20:65 doi: 10.1186/s12893-020-00725-8.

Article Statistics :Views : 228 | Downloads : 207 : 33