A Study of Comparison of Single Vs Double Drains Post - Modified Radical Mastectomy

Abstract

Background: The number of drains after a Modified Radical Mastectomy (MRM), the most common surgery for women with breast cancer, is still up for debate. The objective of this research is to find clinical results pertaining to patient comfort, pain ratings, seroma development and drain production.
Methods: A prospective, non-randomized, observational research study was conducted at Sri Ramachandra Institute of Higher Education and Research, Chennai, from November 2022 to April 2024. There were formed two groups of eighty-four female patients undergoing MRMs: (a) Single Drain Group (n = 42). The axilla has a single drain, (b) Double Drain Group (n = 42): One drain in the bottom flap and one in the axilla. Postoperative parameters such as drain removal time, pain ratings (Wong-Baker FACES), seroma development (clinical and ultrasound), and daily and total drain output were subjected to analysis. Logistic regression, independent t-tests, chi-square testing, Mann-Whitney U tests, and Kaplan-Meier survival analysis were executed in SPSS v26.0.
Results: The single drain group had considerably lower daily drainage volumes from POD-1 to POD-10 (p < 0.01) but had total drain output similar to other groups (p = 0.743). It also took longer for the single drain group to remove the drain (8.57 vs. 7.12 days, p = 0.014). They found that the single drain group had considerably lower POD-9 pain levels (p = 0.024) and thus possibly more comfort post-surgery. Seroma development rates were statistically equivalent (p = 1.000) among groups. Logistic regression analysis also showed that diabetes mellitus was significantly associated with seroma development (p = 0.04), but drain type was not related to seroma risk (p = 0.88). Prolonged drain retention in the single drain group was also shown by Kaplan-Meier analysis (p = 0.032).
Conclusion: As MRM, single drain insertion results in better pain control, patient comfort, and drainage efficiency as well as seroma risk similar to double drain insertion. Given these results, it is also suggested that the ideal postoperative strategy is using a single drain. More study is warranted to assess long-term results and to improve drainage techniques in breast cancer surgery.