Is breast drainage surgery painful?

Drainage surgery is a relatively mature surgical method. Most of the time, an incision is made at the epidermis of the skin to drain the pus in the body. But is breast drainage surgery painful? Anesthesia is required before surgery, so the patient will not feel pain. However, if the anesthetic effect has disappeared after anesthesia, there will be more obvious pain, and it will take one to two days to recover before the pain is gone.

There will be obvious pain after anesthesia, but it is similar to the pain after other surgical anesthetics, and there is no more severe pain. Generally, if the recovery after surgery goes smoothly, breast incision and drainage can be resumed within one to two weeks for the treatment of breast abscess formed by acute mastitis.

Indications

Breast incision and drainage is suitable for inflammatory masses around the nipple or in the breast tissue that begin to soften and show a sense of fluctuation; deep infection that forms an abscess, where pus breaks through the breast fibrous capsule and enters the honeycomb tissue behind the breast, and the pus is suctioned out through ultrasound examination or puncture; and mixed infection of breast tuberculosis.

Preoperative preparation

Use antibiotics or other antimicrobial drugs. Local hot compresses promote localization of abscesses. Use a bra to reduce congestion and heaviness.

Anesthesia and positioning

General anesthesia facilitates complete drainage. Local anesthesia has a poor analgesic effect and is suitable for drainage of superficial abscesses. Anesthetic solution can also be injected into the space between the breast and the pectoralis major muscle.

Surgical procedures

1. Make more radial incisions extending outward from the nipple. You can also make horizontal incisions with a slight arc depending on the location of the abscess. If the two ends of the incision extend beyond the abscess to the normal breast tissue, it may cause breast fistula. The incision should not be too small. If the incision is bottle-mouth-shaped at the top of the abscess cavity, drainage will be inadequate and healing will be delayed. For abscesses around the nipple or above the breast, an arc-shaped incision can be made at the edge of the areola or in concentric circles. For deep breast abscesses located in the lower quadrant, a thoraco-breast incision along the breast fold can be chosen, which not only ensures smooth drainage but also reduces scar tissue.

2. First puncture the abscess cavity to determine its depth, then make an incision at the top of the abscess cavity, appropriately separate the subcutaneous tissue and insert the vascular clamp directly into the abscess cavity along the direction of the needle. After the pus is discharged, the incision needs to be enlarged.

3. Insert your fingers through the incision to separate the abscess cavity partitions, so that the small partitions are completely penetrated and the separated necrotic tissue is discharged.

4. For superficial abscess, flush the abscess cavity with isotonic saline after drainage and drain with vaseline gauze or rubber sheet. If you use your fingers to explore the bottom of the abscess and find that the abscess cavity is large and the incision is high, you should make another incision at the best position for gravity drainage to facilitate drainage. Place a strip of vaseline gauze or a rubber sheet or a rubber tube, secure it to the skin or use a safety pin to prevent it from slipping into the abscess cavity, loosely pack the area with vaseline gauze, and cover with a gauze bandage.

5. Retrobreast abscess is located between the breast and the pectoralis major muscle fascia and is difficult to drain from the front of the breast. During the operation, the breast is pushed upwards, and an arc-shaped incision is made along the fold where the breast meets the chest wall at the outer or inner lower edge of the breast, depending on the location of the bottom of the abscess. Then, blunt separation was performed with vascular forceps to reach the abscess cavity in the space before the pectoralis major fascia. After draining the pus, insert the finger, separate the fibrous septum of the pus cavity, remove most of the necrotic tissue, and then flush the pus cavity with isotonic saline or 3% hydrogen peroxide solution. Place a drainage rubber sheet (or tube) or vaseline gauze and secure the drainage properly to prevent it from dislocation. Apply gauze bandage. 6. Pus should be cultured for bacteria. For patients with recurrent chronic breast abscesses, the abscess cavity wall should be excised for pathological examination.

Postoperative care

The following treatments are performed after breast incision and drainage: After covering with a sterile dressing, use a wide chest strap or bra to lift the breast to relieve the pain, continue to use antibiotics and other anti-infective drugs to control the infection until the patient's body temperature returns to normal. The outer dressing should be replaced on the second day after surgery. On the 3rd to 4th day after surgery, if the drainage gauze becomes slightly loose, it can be removed and the drainage material replaced. If a drainage tube has been placed, it can be flushed with isotonic warm saline during daily dressing changes. The amount of pus drainage gradually decreases until only a small amount of discharge is left and the drainage can be removed. After drainage, hot compress and physical therapy are used to promote the absorption of local inflammatory infiltration. Breastfeeding can be continued after the inflammation subsides. If cellulitis in the breast area is obvious, breastfeeding should be stopped and the milk should be drained with a breast pump to reduce congestion in the breast tissue or medication should be used to inhibit milk secretion. If there is milk leakage or the patient voluntarily weans, 5 mg of ethidium bromide can be taken orally 3 times a day for 3 to 5 days.