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My Surgeon Did Not Put in Drains at All. Is This OK?

He said most bodies will just absorb the fluid. However, this is not the case with me. My lower abdomin keeps filling up and I have had to go have it drained manually by the Dr 3 times now in 2 weeks. I could have gone even more but suffer through the swelling untill I can't stand it anymore.

Doctor Answers (7)

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


Phoenix Plastic Surgeon
5.0 out of 5 stars 26 reviews

Drains are not always necessary.

+1

A seroma (collection of fluid) is a potential risk that can happen even if drains are used.  While most plastic surgeons do use drains for their tummy tuck, more and more (including me) have stopped using them and instead use a modified form of a tummy tuck that does not require a drain.  I have been performing this new technique for almost three years now and I've had only two seroma, which is same rate if not better than what is published for traditional tummy tuck technique with drains.

When a seroma does occur it is not dangerous but it sure is annoying.  You have a choice of going for multiple aspirations or just have a small seroma catheter placed in there.

 

Sincerely,

Martin Jugenburg, MD, FRCSC

Plastic and Reconstructive Surgeon

Toronto, Ontario

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

Drains and TT

+1

Personally, I always use drains in my tummy tucks.  However, there is an alternative method that some surgeons use - called "quilting sutures" or "progressive tension sutures" that is said to eliminate the need for drains by its advocates.

If you are continuously making fluid, you might require a drain to be placed.  Sometimes a small percutaneous drain called a Seroma-Cath can be very helpful for this situation.  This does not require a trip back to the OR to place...it's like starting an IV.  

 

Good luck.

Thomas Fiala, MD
Orlando Plastic Surgeon
5.0 out of 5 stars 25 reviews

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Drains after tummy tuck

+1

In my experience, drains are absolutely necessary after an abdominoplasty or "tummy tuck" procedure.  Two drains are usually placed at the level of the incision to collect inflammatory fluids and byproducts that naturally occur after surgical procedures.  Drains stay in anywhere from 7-10 days or until the surgeon feels that the drain output is minimal enough that your body can absorb whatever else is excreted.  Unfortunately, because you did not have drains placed during your surgery, the naturally occurring inflammatory fluid has been collecting underneath your incision. It is necessary to have this drained manually (with a needle and syringe) and it is not uncommon for this to have to be done several times. Eventually, your body will stop producing this fluid and you will not need to be manually drained by your surgeon anymore.  Best wishes.

C. Andrew Salzberg, MD
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Drains not always necessary with tummy tuck if progressive tension sutures are used

+1

Many surgeons using a technique called progressive tension suture method (PTS) do not find that drains are necesary since the amount of fluid accumulation is very low with this technique. However, I still use a drain with PTS and it typically comes out in a few days.

Richard Baxter, MD
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Drains for Tummy Tucks

+1

Thank you for your question.

In my practice, I generally use 2 drains for a standard tummy tuck. I remove the drains when I see that the fluid coming out of the drains is below a certain amount.   The drains are used to reduce the risk of seroma after tummy tuck surgery.

Sometimes when drains are removed, the patients body will still produce excess fluid that will need to be aspirated.  The fluid amount should reduce with time.

Best Wishes.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 707 reviews

Drains for Tummy Tucks

+1

Most plastic surgeons do use drains for tummy-Tucks. Actually, most use 2 drains as the risk of post-op seromas or hematoma is high with tummy-tucks due to the intrinsic extensive undermining of the skin and also for the common concomitant liposuction performed during the procedure.  In my practice in Toronto, I use 2 drains with post-op oral antibiotic coverage:  one gets removed at 5-7 weeks, the other one at 10-12 days.  I have not had a seroma since I started this protocol 5-6 years ago.  A way to minimize seromas post-tummy-tuck is to use quilting sutures to minimize the so-called dead-space and to minimize the use of electrocautery.  Dr. M. DuPéré, Board-Certified Plastic Surgeon, VISAGE Clinic, Toronto

Marc DuPéré, MD
Toronto Plastic Surgeon
5.0 out of 5 stars 36 reviews

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.