I am planning a Tummy Tuck soon & the Dr I have chosen said he prefers to do internal sutures as opposed to drains. I have heard that might be more dangerous. What is the reality?
Drains Vs Internal Sutures for Tummy Tuck?
Doctor Answers 19
Tummy tuck without drains
This is a rather new technique that is gaining more popularity. I have done it several times with good success. I wouldn't say that's it's more dangerous, it just might slightly increase the possibility of a seroma forming (fluid collection). The benefit of internal sutures is that no drains are necessary which is a great postoperative perk.
The downside is that it may increase the formation of seroma, but again, this is only slight. If a seroma does form, it is easily drained in the office without any difficulty or negative consequences. I usually discuss this with the patient preop and we both come to a decision. Good luck!
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Drains vs. internal sutures in tummy tuck
"An ounce of prevention is worth a pound of cure." The definition of tummy tuck varies widely, but in my O.R .it includes: muscle repair, aggressive suction, skin and fat resection,and umbilical reconstruction. I've used drains for 27 yrs. without problems.
In these abdominal and flank reconstructions--which may or may not be what you will have I do not use "quilting sutures" but use drains as the "ounce of..."
I stopped using internal (quilting) sutures for tummy tuck
A Tummy Tuck (Abdominoplasty) requires a lifting and separation of the skin / subcutaneous fat from the underlying muscles.
After the muscles are brought back to the midline, the loose, excess lower tummy skin and fat are removed and the surgical incision is closed, we want the skin and fat to adhere back to the underlying muscles. Unfortunately, fluid collections (seromas) tend to form in that space.
As long as drains remove the fluid as soon as it forms, the skin adherence/healing goes on schedule. But, patients would wish there was ANOTHER way to prevent the use of drains. Many methods were tried; some less gentle than others.
The placement of internal quilting sutures was popularized by Drs. Pollock, father and son Dallas plastic surgeons. I HAVE used this techniques but found that it did not work better than drains. I therefore stopped using it. I think most plastic surgeons share my opinion.
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Internal sutures (quilting) versus drains with tummy tuck (TT) abdominoplasty
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These internal sutures (also called quilting sutures) have been recommended to minimize the potential for fluid collection between the fat and muscle. Traditionally in the past, these fluid collections were treated with drains. The thought with the sutures is that if you close the space, the fluid will not accumulate.
In reality, I have performed both techniques and still have fluid collections. Because the sutures take more time, I have abandoned this method and have returned to drains. I have designed a drain which forks (splits) into two (internally) and therefore I use 1 drain opening that drains two areas.
Drains Vs Internal Sutures for Tummy Tuck?
Although these different opinions can be confusing and a source of anxiety for patients, it is good for patients to understand the different options available. Ultimately, it will be up to each patient to do their due diligence and select their plastic surgeon carefully. Part of this selection process will involve the patients becoming comfortable with the plastic surgeon's experience level and abilities to achieve their goals as safely and complication free as possible. In my practice, I currently use drains for all tummy tuck patients; I also use progressive tension sutures for most patients.
I hope this, and the attached link (dedicated to tummy tuck surgery concerns), helps.
Safe when performed by experienced board certified plastic surgeon
Progressive tension sutures use absorbable sutures that close any cavities inside your body that are created after tissue removal, minimizing the risk of seroma/hematoma and making drains unnecessary. It can reduce the risk of infection and your recovery tends to be faster than if drains were used. However, thinner patients may require drains. That's why you have to get a consultation to see which technique would be best for you.
Drains and Tummy Tucks
More recently, 'drain free' surgery has become more popular. Fat layer is sutured down to the muscle layer starting at the ribs and progressively down to the lower incision. This makes the space for the fluid to collect much smaller, and in many patients can have surgery without drains. However, I have seen multiple patients come from other surgeons because they developed a seroma despite the suturing of the tissue. This is not the surgeon's fault, but some patients just do not heal fast enough or put out too much fluid for the body to absorb.
Pablo Prichard, MD
Use of drains and internal sutures for Tummy Tuck
This is a great question.
Personally, I am a believer of "tried and proven" techniques. Drains after tummy tuck surgery have been used for decades and are safe and effective. Seroma develops after tummy tuck surgery due to movement of the abdominal skin against the abdominal wall. The theory behind internal sutures is to keep the skin from moving. However, there is NO way the entire internal abdominal skin can be sutured. There will be pockets of skin, therefore, with some movement.
I suppose the only way to determine if internal sutures is as good as drains is to have one side of the patient with drains and the other side with internal sutures and then compare the results. Enough patients need to be in the study to determine is the difference is statistically significant. I personally do not perform internal sutures due to additional surgery time and lack of evidence it makes a huge difference.
Personally, I do both drains and internal sutures for Tummy Tuck
As one of the other doctors mentioned, I do a combination of both quilting sutures and drains.I have been doing this combination for about 5 years. Since I starting doing quilting sutures I would say my drains stay in shorter (usually about 1 week) and I have reduced the occurrence of fluid collections postop. I would ask your doctor how often he sees fluid collections without drains. If he has good success with his technique you should be OK to proceed.
Tummy tuck drains or internal sutures
I personally do not use quilting sutures. The literature as it stands today seems to indicate that either drains or quilting sutures are adequate in minimizing fluid collections. The use of both is probably overkill and may add time to the operation that would increase risks that are based on longer anesthesia times. Good luck!
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