Effect of drain omission after mastectomy on cosmesis, patient satisfaction and interval to adjuvant therapy

Omission of closed suction drains in women undergoing simple mastectomy has become the standard in the United Kingdom (UK) with studies demonstrating no difference in symptomatic seroma rates or complications. A theoretical concern is that a large-volume seroma distorts the skin envelope, potentially resulting in inferior long-term postoperative aesthetic appearance and patient satisfaction. Furthermore, the seroma may lead to a delay in adjuvant treatment, in particular, chest wall radiotherapy. There is currently no objective scoring system to evaluate the postoperative appearance after simple mastectomy.

Patients who had undergone a drainless unilateral simple mastectomy at the Royal Marsden Hospital attending for annual surveillance contralateral mammography between October 2016 and July 2017 were invited to complete a BREAST-Q questionnaire and attend medical photography for panel assessment of aesthetic outcome. Patient satisfaction in this cohort was compared with results from the UK National Mastectomy and Breast Reconstruction Audit (NMBRA) 2011, which was conducted at a time when surgical drains were routinely placed.

The proportion of patients satisfied with their appearance was similar to that of NMBRA 2011. BREAST-Q results were in line with the published literature. A panel assessment scoring system for simple mastectomies was developed. There was no difference in delays to adjuvant treatment between the study and NMBRA cohort.

Omission of drains in women undergoing simple mastectomy did not result in inferior aesthetic outcomes or lower patient satisfaction, nor did it result in delay to adjuvant treatment. BREAST-Q results were in line with the literature. A panel assessment scoring system for simple mastectomy was developed.