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Drains or Quilting Sutures for TT?

I've had 2 consults for a full TT with breast implants. Both surgeons were highly recommended, board certified, 30+ yrs experience. One uses quilting sutures, no drains and lipo to sculpt entire area. Other surgeon uses drains and very Iimited lipo. Of course I'd prefer no drains and I think I'd need lipo on the upper abdomen to get a smooth result. But is this way of doing it safe? Are there increased risks? And if not, why don't all surgeons do quilting method? (I'm 39, 5'3", 123#, healthy)

Doctor Answers (15)

Drains or Quilting Sutures for Tummy Tuck?

+3

Not having drain tubes after Tummy Tuck surgery is obviously a very attractive proposition. The quilting sutures are NOT new and have been with us for over 10 years. The questions are: does it work in everyone? What are the consequences of NOT using drains?

I was trained to do Tummy Tuck surgery with the use of drains. Years later, I switched to the use of quilting sutures as proposed by Drs. Pollock of Dallas and used various configurations with and without drains. I even used such quilting sutures without drains after spraying the wound with Fibrin glue to promote faster adherence of the walls. After encountering a series of fluid collections (seromas) and having to perform multiple syringe aspirations in these women I have given this up and returned to the use of drains. My seroma rates have then plummeted to less than 5%.

Plastic surgeons are NOT conservative in nature and try new things ALL the time (driving our OR nurses who hate change crazy). I suspect the middle age and older surgeons share my experience. The younger guys will eventually join us as well in seeing the wisdom of drains.

I hope this answered your question.

Peter A Aldea, MD

 


Memphis Plastic Surgeon
5.0 out of 5 stars 60 reviews

Why not BOTH drain and quilting sutures?

+3

This is not how you choose a surgeon! A drain is useful to reduce fluid that collects in the cavity created by raising the skin flaps. Quilting sutures help to tack the skin flap down, but cannot completely eliminate the residual "dead space" where fluid collects. Why not use both, reducing the length of time the drain has to be left in, and increasing the likelihood that once it is removed that there is sufficient healing to prevent fluid from reaccumulating and aspiration via needle stick being necessary? When liposuction is performed with tummy tuck, the surgeon has to be careful to avoid damaging the blood supply to the lower abdominal skin by over-aggressive suctioning of the upper abdominal areas through which these blood vessels flow. Also, lipo increases the fluid that the body (or drain) must deal with. The vast majority of plastic surgeons use drains with tummy tucks; when lipo is added, I suspect the number goes up even more!

Just because some surgeons use quilting sutures and no drains does NOT mean they never have fluid accumulation, for which aspiration or later drain placement is necessary! Oh, but then you lose the "marketing" aspect of being able to say "I don't use drains; I use quilting sutures!"  If a surgeon asserts this, then you should ask them if they EVER have had fluid collect in a TT patient, or if they EVER had to place a drain later. Maybe they just ignore the fluid. See questions about seroma here on RS for these surgeons' patients!

Denial is not a river in Egypt! I'd go with the surgeon who does limited suction and uses a drain; he sounds safer to me! But you talked with both of them; listen to your head and your gut!

Richard H. Tholen, MD, FACS
Minneapolis Plastic Surgeon
5.0 out of 5 stars 118 reviews

Tummy tuck is safe without drains

+2

Tummy tuck is safe without drains with a very low complication rate. It seems by reviewing this site that the techniques are controversial, though tummy tuck without drains is widely practiced, and the techniques are published, and repeated by many. You can have a great result with or without a drain, and the key issue is which surgeon do you put your trust and faith in. A drain is a secondary concern.

Best of luck,

peterejohnsonmd

Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 27 reviews

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New way of doing a tummy tuck - NO DRAINS

+2

The use of quilting sutures is becoming more and more popular.  This technique does not require the use of post-surgical drains and is perfectly safe and acceptable.  I have been performing all tummy tucks for about 18 months now and I am very happy with the outcomes.  Some surgeons have not yet considered the use of quilting sutures or just don't feel comfortable to change a technique that has worked for them for many years.  It doesn't mean that the newer technique is in any way inferior.

Sincerely,

Martin Jugenburg, MD

Martin Jugenburg, MD
Toronto Plastic Surgeon
5.0 out of 5 stars 135 reviews

Go with whoever you feel confortable with

+2

Each surgeon has his/ her way of doing tummy tuck. Just choose the one that you feel confortable with. The drain should not your biggest concern.

Moneer Jaibaji, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 3 reviews

Drains and Tummy Tucks

+1
Thank you for your post. Whenever there is a potential space in your body, your body tends to fill that space with serous fluid (the yellow type of fluid that also comes out of a 'weeping wound'. This is similar to when you get a blister: the layers of skin separate and fluid is deposited in to the space. In a tummy tuck, the space is in between the skin/fat layer and the muscle layer. Most surgeons will place a drain to remove this fluid while your body is secreting it until the fat layer grows back together with the muscle layer. At that point, no more fluid is secreted into the area, because there is no more space for fluid. The length of time that this takes varies from patient to patient. Some patients heal much faster, thus the layers seal together much faster. Also, the more twisting motion you have in your belly area, the slower the two layers grow back together because they are moving in relation to each other. The fluid coming through the drain can be initially dark red, and eventually clears to pink then yellow. This is because it takes just a little bit of blood to make the fluid dark red. Also, initially, there can be a large amount of fluid (few hundred cc's in the first day is not out of the range of normal) and this should slow down substantially over next few days. Once the fluid slows down to the amount that your surgeon is comfortable with (usually 25-50 cc in 24 hours) then they will be pulled. There is minimal discomfort in pulling the drain in most patients.
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.
Best wishes,
Pablo Prichard, MD

Pablo Prichard, MD
Phoenix Plastic Surgeon
5.0 out of 5 stars 26 reviews

Drains or sutures..

+1

As you can see from the 3 surgeons responding to your question, there are varying opinions on this issue.   Surgical judgement is based on individual surgeon's training, experience, and published scientific data.  I have been using progressive tension sutures (PTS) with no drains for over thiry years without a single case of post op fluid accumulation (seroma).    We recently published nearly 600 consecutive cases of TT using PTS and NO drains, with only one small seroma (required a single aspiration).  The use of the PTS greatily improves the over  patient experience---No cumbersome drains,  no need to bend over while standing and walking,  and better mobiitity after surgery, since the sutures prevent disruption of early healing.    While our data shows the effectiveness of this suture technique, without using drains,  the use of drains with PTS is the surgeons prerogative .  Your question   "why don't all surgeons do quilting method?"  is a frequent one we hear from our patients and one which I can't  answer.  However, since we introduced PTS in 2000 in a published article, we have been gratified to see increasing  acceptance of this technique .us,  but most important

Harlan Pollock, MD
Dallas Plastic Surgeon
3.5 out of 5 stars 3 reviews

Drains with tummy tuck

+1

Either method is acceptable. I have gone back to using drains because of concerns over seromas(fluid collections). I will suction the upper abdomen at the same time, but some surgeons are hesitant to do so. If I suction, then I think the drains are even more important.

Since either method works, I would choose the surgeon you feel most comfortable with.

Good luck.

Gregory Sexton, MD
Columbia Plastic Surgeon
5.0 out of 5 stars 27 reviews

Drains or Quilting Sutures for TT?

+1

Here Here for Dr. Rand. Drains are for prevention of accumulation of fluids. Quitting is a suture technique that has become a media issue. In my opinion over 90% of boarded PS use some form of drains in TTs. Only 5% use quitting. You do the math, chose upon experience. From  MIAMI 

Darryl J. Blinski, MD
Miami Plastic Surgeon
4.5 out of 5 stars 61 reviews

Tummy tuck, liposuction and quilting sutures

+1

Both approaches are be reasonable. When it comes to liposuction during an abdominoplasty, it can be safely performed in most patients when done in the deeper planes. This will usually result in a thinner and more sculpted final result. As far as quilting sutures go, it can allow avoidance of drains with probably a minimal risk of seroma formation. Most surgeons are simply used to using drains only. Also, plication sutures add more surgical time which may be seen as a drawback.

David A. Bottger, MD
Philadelphia Plastic Surgeon
5.0 out of 5 stars 26 reviews

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