Incisional drainage

Updated: Apr 26

You may see videos all over Instagram of post-op clients being drained during post-op massages. Literally squirting fluid out of the body onto disposable pads.


This has been mistakenly called lymphatic drainage, it's not.


There may be a few different things happening in some of these images.


Some images may be showing draining a seroma, that's not incisional drainage but needle aspiration and it should be performed by an MD/NP maybe an RN in a medical setting with appropriate biohazard medical waste collection and disposal. Since blood and body fluids are considered biomedical waste they should not be leaking or squirting out onto equipment intentionally. When traditionally performed the fluid would be excreted into a collection device like the closed syringe if it's a smaller seroma or a canister. There are state and local laws for disposing of biohazard materials and the needles need to go in sharps containers.


The other phenomenon of incisional drainage appears to be inserting an uncapped needle and performing a "milking" massage and toward the needle to allow for fluid to drain out of the body. While this technique might have some appeal to get faster results reducing the tension of edema by expressing the excessive fluids; This comes with quite a bit of risk not only for the clients but the practitioners that perform it as well.


Infection may be the biggest risk factor by creating a new opening for bacteria to enter the body. Infected surgical sites often cause failed incisions, may need explantation of devices and will prolong healing time. For clients who have surgery out of state/country, this poses even bigger strain on you financially as you may need to seek care through the hospital system or wound centers which insurance may/may not cover.


Reopening incisions also risks the cosmesis of your scar formation. The strength of the skin never completely returns to its normal strength after opening. It's always slightly weaker. Every time an area opens it is weakness stacked on top of weakness. If you go in several times for massage and are forcefully reopened to allow fluid to drain, that's going to create an even weaker point of healing. In another negative aspect, some people tend to heal with keloid or raised scars, repeated reinjury to the site may trigger keloid formation.


For the folks that perform these procedures and are not in a medical facility with biohazard waste removal protocols in place and without an MD/NP on hand to make medical recommendations, this is quite risky in my opinion. It's a liability if you cause harm to any of your clients and that course that you took for post-op certification course you took without accreditation will do little to protect you. Course creators typically warn you to check your state practice act for a reason. It's likely out of your scope of practice if you are a massage therapist to be opening the skin or managing open wounds.


As far as non-invasive ways to treat post-op swelling and seromas, there are so many ways. Swelling is limited by the foods and fluids you consume, compression, getting manual lymphatic massages, and returning to gentle activity. Seromas are often minimized by increasing compression by adding foams to the area. Kinesiotaping has helped to disperse fluid in the area. Seek drainage from an MD/NP at your primary care physician's office you are not local to your surgeon. They may be drained but they also may inject medication to prevent them from refilling. Likely compression will be recommended afterward prevent another episode.


Here is a video of taping that you can easily try at home.



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@If you are an LMT that sees clients with wound needs; Let's get connected so you're clients have access to a Certified Wound Specialist. Drop me a message at betterwounds@gmail.com



Medical Waste | Background | Environmental Guidelines | Guidelines Library | Infection Control | CDC


A Simple, Safe Technique for Thorough Seroma Evacuation in t... : Plastic and Reconstructive Surgery – Global Open (lww.com)

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