Single Versus Double Drainage Insertion After Total Mastectomy and Axillary Dissection

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.

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.

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).

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.