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To the Editor.—I would like to offer a solution to the problem posed by Drs Becker, Sener, and Scanlon in their report (Archives 1982;117:859). Passive drainage, either alone or following vacuum suction, is insufficient; so are "pressure" dressings by themselves.
The developed subcutaneous space following any mastectomy is no different from that resulting from other operations involving flaps and reconstruction. The maximum rate of serum accumulation occurs 48 to 72 hours after surgery and the actual drainage of this serum is needed only for that interval plus one or two days more. There is no way that actual "pressure" can be brought to bear on the site. The essential point is that a circumferential wrap over a bulky dressing provides gentle support to the cutaneous flaps. Without that support, the flaps sag away from the chest wall and will shear away from the underlying muscle with each movement of