New Kits Help Patients Manage Fluid Drainage after Lumpectomy, Mastectomy, and Breast Reconstruction (dateline January 13, 2000)

Lumpectomy (removal of a breast lump) and mastectomy (removal of the breast) are common surgical treatments for breast cancer. After lumpectomy and mastectomy, many surgeons will place a plastic or rubber drainage tube in the breast or under the arm to help remove blood and lymph which accumulates during the healing process. Drainage tubes are usually not removed until the drainage is reduced to less than 30 ccs (1 fluid oz) per day. During this period, some women experience significant discomfort and pulling from the drainage tube. A new post-surgical drainage kit has recently been developed to help women take care of their drains after discharge from the hospital .

The idea for a post-mastectomy drainage kit came about after Carol Outland underwent a modified radical mastectomy in 1989. After surgery, Carol awoke with tubes dangling from her chest. The tubes were attached to drainage bulbs, which were pinned to her hospital gown. On a trip to the bathroom, one of the tubes was nearly pulled out after it got caught on the doorknob. Frustrated with the pain and awkwardness of the drainage tubes, Carol asked her husband to bring her Walkman belt bag to the hospital when he visited her. Carol proceeded to unpin the drains and place the drainage bulbs and tubing in the Walkman belt bag so that she could move about the room more easily.

After she was discharged from the hospital, Carol experimented with different ways to secure the tubing. She sewed Velcro tabs on the belt to hold the tubing in place and prevent the loops from tangling. She also added a holder to the back of the bag rather than sewing the bag in place on the belt, enabling the bag to slide freely from one side of the body to the other. Carol’s physician at the University of Chicago was impressed with her innovation, and for a short time, Carol tried to make and market the bags herself. However, since she lacked the expertise necessary to market the belt bags, Carol decide to give them up for a while and continue her primary career.

After her mastectomy, Carol initially had breast reconstruction using implants. After several years and a number of complications with both silicone and saline breast implants, Carol opted for a TRAM flap procedure to rebuild the contour of her breast. Since TRAM flap procedures typically require the insertion of three or more drains after surgery, Carol decided to attach two bags on her belt to hold the multiple drains. Carol’s plastic surgeon at the University of Chicago again asked her to consider making bags for other patients undergoing lumpectomy, mastectomy, and breast reconstruction. Carol began to work on the bags with a colleague who was part of a new company called Care Products, Inc. Care Products, Inc. was already distributing a Post Breast Surgery Kit that included instructions for self-care and supplies to take care of drains after surgery. The women at Care Products, Inc. added the belt bags to their kit and re-named them Careguide Kits. Many hospitals now use the Careguide Kits, including Johns Hopkins and Rush Presbyterian-St. Lukes Medical Center of Chicago. Careguide Kits are also supported by several organizations including the American Breast Cancer Foundation, Y-ME, the Susan G. Komen Foundation, and the National Lymphedema Network.

A major component of the post-mastectomy drainage kits is the belt bag. Instead of pinning drainage tubes to gowns or undergarments, a woman may place her drainage bulb in the belt bag for easy mobility. When showering, a woman may wear one belt bag, hang it to dry, and use the other belt bag while the first one is drying. A typical kit includes:

• Two belt bags
• A ten-day supply of non-latex gloves, gauze pads, swab sticks, adhesive tape remover pads, split dressings with foam bar, and waste bags with ties
• Antibacterial soap and 2 rolls of medical tape
• 10 measuring cups to measure drainage. As the mastectomy site heals, fluid drainage should decrease and can be tracked via measurement.
• Drainage record card and pencil to record the amount of drainage accumulated each day.
• Post-operative exercise instructions. Patients should discuss these exercises with their physician before practicing them.
• A document from the National Lymphedema Association explaining how to help prevent lymphedema (chronic swelling of the arm). Lymphedema is a potentially dangerous condition that can occur after breast surgery.

Each kit also contains step-by-step instructions with full color illustrations. Instructions are also available in Spanish and other languages. Women who still have difficulty using the drainage kits may call a toll free number for assistance. All kits are packed by assembly lines approved by the U.S. Food and Drug Administration (FDA).

The post-surgery drainage kits allow women to obtain all of the necessary supplies to care for their drains at one time. Besides building confidence and alleviating some of the stress associated with breast surgery, using a drainage kit may reduce the number of calls a woman has to make to her physician or nurse after surgery.

Care Products, Inc. sells two types of kits for patients who have breast surgery: a kit designed for routine mastectomy and a kit for more complicated procedures requiring multiple drains (such as TRAM flap breast reconstruction). The post-surgery drainage kit costs just over $50 with shipping. A refill of 10 dressing changes costs around $30 with shipping. Many health insurance companies will cover the cost of the kits used after lumpectomy, mastectomy, or breast reconstruction.

Additional Resources and References

• Care Products, Inc. provides information and ordering instructions for Post Breast Surgery kits and refills online at http://www.careguidekit.com/ or by calling 1.877.CARE.KIT (1.877.227.3548). The company also manufacturers kits for a variety of other situations including cardiac surgery, asthma, burns and scrapes, open wounds, and circumcision aftercare.
• To learn more about mastectomy, please visit http://www.imaginis.com/breasthealth/mastectomy.asp
• To learn more about fluid accumulation (seroma) after breast surgery, please visit http://www.imaginis.com/breasthealth/news/news10.21.99.asp