What's the evidence based rationale for a compression garment after a TT? My PS isn't having one for my B/L breast lift (anchor incision); just TT, yet I'd think the disruption of flesh to underlying tissues would be the same for both sxs. I've read the comp. may reduce circulation, and possibly cause "flap death", and is uncomfortable. Yet, I hear the comp. reduces swelling (wouldn't that just be for a few days though?), and helps lymph system re-establish. Thanks so much!
Is a Compression Garment Essential, Why, and for How Long After Tummy Tuck?
Doctor Answers (11)
Compression garment after tummy tuck
Do you absolutely have to wear a compression garment after your tummy tuck? No, you do not. Why do most plastic surgeons suggest it? Because it helps the skin and fat that are lifted up during the tummy tuck procedure stick down faster which decreases swelling and also decreases the potential for fluid pockets to develop. What will happen of you don't wear it? Most likely nothing but it does increase your risk of developing fluid pockets (called seromas). Why do you not need one for the breast lift? This has to do with the manner in which the operations are performed. During a tummy tuck a large amount of skin and fat are lifted up creating a potential space for fluid to accumulate and complications to occur. There is not nearly this large space created with a breast lift, and so usually a compression garment is not necessary. Hope these answers help. Good luck with your surgery.
Questions about wearing a compressive garment for a tummy tuck and breast lift
Your question and rationale for your opinions are very interesting and show much thought. The natures of the tummy tuck and breast lift including the extent are far different so using a binder for one but not the other is not irrational.
Most plastic surgeons do use a binder for a tummy tuck for a variety of reasons, particularly discomfort control, support, security and even help in reduction of swelling - and it is based on intuitive thinking as well as experience. However, there is no large evidence based study for either procedure to definitively support one approach. I personally use binders for tummy tucks and supportive bras for breast lifts. These latter do supply slight compression but it is to a lesser degree than that for a tummy tuck. One doesn't want too much pressure for either garment as this can be detrimental regarding blood perfusion.
To add another caveat: Plastic surgeons usually have their own preferences for doing certain things - and that does not necessarily mean that their way is right or wrong. It is what works for them and their patients.
Tummy Tuck Compression Garments
Most tummy tuck patients feel better and have an easier time changing positions (laying to sitting, sitting to standing, etc) and ambulating with the feeling of abdominal support that a compression garment provides. My preference is to start patients out with a three-panel, Velcro-fastened abdominal binder that is easily applied and removed. This allows easy access to surgical dressings and easy inspection of the abdominal skin in the early postoperative period.
Patients are placed in a form-fitting but comfortable compression garment at their postop day two appointment after the On-Q catheters (local anesthetic infusion system for postop pain control) are removed. The garment should cover the entire trunk, and ideally should incorporate breast coverage to keep the garment from slipping downward. It should have an open crotch (panties are worn over the garment) so that it does not need to be removed for every trip to the bathroom. Most patients seem to prefer a garment that includes the upper thigh (rather than a 1-piece swimsuit-style coverage at the hips) so that it does not ‘pinch’ in the hip or groin area, although we give patients that choice.
Compression also helps to control the subcutaneous edema that is a normal part of abdominoplasty recovery. The process of elevating the abdominoplasty flap (as well as liposuction of the central subcutaneous portion of the flap which is required in most patients) temporarily impairs normal lymphatic drainage. The lymphatic system is responsible for directing fluid that leaks out at the capillary level from the vascular system back to the venous system. Because lymphatic drainage is impaired, it is quite common for subcutaneous edema (swelling) to develop in the flap – which persists until the remaining lymphatic channels recover and new ones develop. Some patients have very little edema postop, and can discontinue the use of their compression garment earlier.
Often we have patients wear one, two or three panels of the initial binder over their compression garment to provide added comfort and control of edema. The degree and duration of subcutaneous swelling / edema is definitely reduced by the use of compression garments. We direct patients to wear them as close to around-the-clock as possible for the first two weeks postop, and then all day or all night for the second two week period.
Not all compression garments are created equal. As with surgeons and surgery centers, you tend to get what you pay for. In my practice we provide the compression garments for abdominoplasty patients (there is no added fee for compression garments), and we have tried out almost every major company’s garments. We have been happiest with Marena’s compression garments as the fabric is very soft, elastic and comfortable yet durable. They are also the most aesthetically pleasing garments we have used. If modified with scissors the fabric does not ‘run’ or split.
If the garments are not pleasant to wear then patients will inevitably discontinue their use earlier than would be ideal. Some practices ask patients to purchase their own garments (I’ve even heard of patients being sent to Wal-Mart for this), which is leaving an important part of the postop care regimen in inexperienced hands. If a practice advises you to purchase your own compression garment, they are probably more interested in controlling costs than your postoperative comfort.
In responses to questions about compression garments, some surgeons have proposed a number of potential negative consequences related to the use of compression garments in abdominoplasty patients: patient discomfort, abdominoplasty flap ischemia (reduction of blood flow), interference with incision inspection and management, etc. These are all problems related to ill-fitting and/or inelastic compression garments. Patients must be carefully measured for a custom-fit garment preoperatively, and garment fit must be carefully monitored postoperatively. If a one-size larger or smaller garment is needed, we discontinue the current garment and have a new one sent by overnight delivery to the patient’s home.
I am not dogmatic about compression garment use. If a patient states that they would prefer not to wear it, or would prefer to discontinue its use early, we allow the patient to do so. That being said, the vast majority of our patients wear their garments for the full four-week protocol, and some use them for longer than four weeks on their own volition. Garment fit and comfort is everything. If the fit is right and the patient is comfortable, then patients feel better, have a more pleasant recovery, experience less edema and more rapidly return to normal activity.
Another important consideration: there is no convincing evidence that the use of compression garments reduces the rate of hematoma or seroma after abdominoplasty. The most important consideration with respect to avoiding postoperative hematoma and seroma is this: following your surgeon’s activity restrictions to the letter. Excessive early activity and too rapid a return to exercise definitely increases your hematoma and seroma risk, so make sure that your surgeon has carefully outlined a plan for your return to activity.
Our recommendation for abdominoplasty recovery is this:
- Walking only for the first two weeks (casual, non-exercise walking). Walking is highly encouraged and the amount is not restricted, as long as it is casual walking.
- Light, non-impact aerobic exercise in weeks three and four – an elliptical trainer is ideal, and initial use should be brief and low-effort. Effort can gradually increase through the end of week four
- Gradual return to usual exercise regimen in weeks five through eight, with unrestricted activity at the end of week eight.
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Compression Garments after Tummy Tuck
Compression can cause pressure necrosis, but I have never observed this after hundreds of tummy tucks. Obviously technical factors during surgery play into this, and every surgeon is different. Compression is thought to reduce fluid collections and is the primary indication. Unrecognized fluid collections can cause contour deformities that can prove difficult to fully correct.
Compression after tummy tuck
Most of my patients feel better with a compression garment after tummy tuck as it provides support. I don't however require it. I am not aware of any studies. I will say if that if there is compromise of the abdominal flap noted in the operating room then compression is not a good idea. Trust what your PS recommends.
Is a Compression Garment Essential
Best of my knowledge, there are no valid comparison studies. I like them because most patients find them comfortable, and many wear them beyond the time that I recommend. They also allow for holding in place gauze dressings without the use of tape which often is changed a number of times. Most of us feel that compression reduces the chance of seroma formation. (Seroma is much less common after breast surgery.)
That said, when a patient finds them uncomfortable, I am quick to abandon the use of compression garments.
Thanks for your question, best wishes.
Compression after a tummy tuck to prevent seroma
The compression garment after a tummy tuck is part of the equation to prevent seromas - the undermining in a tummy tuck is more involved than a breast lift.
Compression Garments Are A Mixed Bag
Compression after a Tummy Tuck
Every doctor has their opinion on how long a patient should wear their compression garment. For abdominal surgery I recommend at least 6 weeks, sometimes longer is they still have some swelling. For breast surgery I have my patients wear a sports bra without any underwire for 6 weeks as well. Compression garments help reduce swelling faster as it can take 3 months to a year for all swelling to subside. Garments also lower the risk of seromas that can develop and lead to infections. I recommend consulting with a plastic surgeon for examination and to go over all of your post-operative concerns.
Compression garments in tummy tuck vs. breast lift?
Hello and thank you for your question.
As you may guess, different plastic surgeons have different ideas over when and why to you compression. I use compression in many of my surgeries, but it is mild compression. In a TT, there is a very large area of tissue elevation over the entire abdominal wall muscles. In the breast there is less so. Also, the breasts tend to be somewhat heavy and push the tissue toward the body while the abdomen is less so. In addition, when you twist your abdoment, there are shear forces between your fat layer and muscle layer as you rotate that doesn't happen in the breasts. Seromas or fluid collections are much more likely to happen in a tummy tuck rather than a breast lift, and thus, surgeons are more apt to use compression to help avoid this.
Pablo Prichard, MD
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.