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Why Am I Not So Swollen After Extended Tt with No Drains?

I am almost two weeks post op after an extended abdominoplasty with no drains. i do wear my Spanx 24/7 except in the shower. I was expecting much more swelling and what I have. I am a little bit swollen above tthe incision but that is it pretty much. is this normal or will the swelling come later?

Doctor Answers (9)

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 28 reviews

Abdominoplasty without drains

+1

I have been using a technique called progressive tension sutures to eliminate the need for drains with my tummy tuck surgeries for the last year or so. I have seen a significant decrease in the amount of post-operative swelling as a result when compared to my previous surgical technique. If your surgeon has used progressive tension sutures, I would say that your lack of swelling is normal. I would not expect for there to be any additional swelling to ever present for you. I think that this technique will catch on as the standard of care for abdominoplasty surgery in the near future for several reasons, lack of post op swelling being one of them. 

William T. Stoeckel, MD
Raleigh-Durham Plastic Surgeon
5.0 out of 5 stars 40 reviews

Why Am I Not So Swollen After Extended Tt with No Drains?

+1

Most have some, often a lot of swelling, but a fortunate few have very little. Consistently wearing your compression garment helps. 

At this stage it would be most unusual to  begin to develop swelling. 

Congratulations on your results, continue to follow your surgeon's recommendations.

Thanks and best wishes.

Jourdan Gottlieb, MD
Seattle Plastic Surgeon
4.5 out of 5 stars 31 reviews

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Swelling After A Tummy Tuck - Will It Get Worse After The First 2 Weeks?

+1

Congratulations.  It sounds like you have had an excellent tummy tuck and it sounds like you have chosen an excellent plastic surgeon.  The greatest amount of swelling occurs within the first week to 10 days after most surgeries including a tummy tuck.  By 2 weeks, you are on the mend and the swelling should progressively decrease.  Having swelling just above the suture line is so common that it may even reach a 100%.  The reason for this swelling is 1) gravity, and 2) the lymphatics that normally drain this area have been cut during the surgery and won't repair themselves for several more weeks.

I doubt seriously if any more swelling will occur unless you overdo it.  Follow your plastic surgeon's directions and again, Congratulations.

S. Larry Schlesinger, MD, FACS
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Lack of swelling after tummy tuck

+1

Congratulations on such an uneventful recovery! Gentle surgical technique, minimal blood loss, a patient with good tissue and sometimes a little old fashioned luck and you and your surgeon are rewarded with a recovery like this.

To answer your question more directly, everyone gets some swelling. The swelling can be mild, moderate or severe. Other than inconvenience, it really doesn't matter because it will resolve in time. The swelling usually reaches its maximum by day 5-7. After that, your body will eliminate the extra water in the tissues at its own rate. You should reach your final resultant contours by 4-6 months. Best of luck!

Mark D. Epstein, MD
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Swelling Following Tummy Tuck

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It sounds like you are experiencing excellent recovery following your tummy tuck surgery. Like  your plastic surgeon, I have been using the progressive tension technique, which enables plastic surgeons to perform abdominoplasty without the use of drains.  Many of my patients have had very little swelling following the procedure, and the compression garments you've been wearing certainly help in this regard. Although it is never possible to predict who will have swelling after surgery, if you are two weeks post-op, I doubt very much if you are going to experience extensive swelling. At times, with increased activity or exercise there can be a bit more swelling. Please contact your plastic surgeon if you have any concerns, but it sounds like you've achieved a great result.  

Steven L. Ringler, MD, FACS
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Swelling after Tummy Tuck?

+1

Congratulations on having undergone the tummy tuck procedure;  good for you that you have experienced no complications.  

 The degree of swelling a patient experiences differs from one patient to another;  generally, there is no good explanation for why one patient experiences more swelling down another does.  it is also hard to predict whether you will experience more swelling in the future, especially as you become more active. Some patients do report increased abdominal wall swelling as they  become more active and/or as they begin to exercise.

For more precise information you should address this question with your plastic surgeon who knows exactly what was done in your case.

 Best wishes for continued uneventful recovery after tummy tuck surgery.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
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Lack of Swelling After Tummy Tuck

+1

It's unlikely that you will develop swelling 2 weeks out from surgery, especially since your recovery has been so good. The best person to ask is your surgeon regarding swelling and the lack of drains after your abdominoplasty. It sounds like your surgeon used a technique called progressive tension sutures to close your abdomen. With this technique there is no need for drains.

Thanks for your question! Congratulations on your new tummy!

 

Gregory C. Park, M.D.

Gregory Park, MD
San Diego Plastic Surgeon
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Everyone swells differently

+1

This is a good problem to have. 

Most experienced plastic surgeons find that their tummy tuck patients take at least a few months for most of the swelling from the surgery to resolve.  I have, however, experienced the rare patients who appears to swell very little after even a big surgery like this.  Be happy that you have very little swelling.  If you don't have it by now, I suspect that you are in the clear.

Wearing your compression garments have probably helped.  It's also possible (although arguable) that the progressive tension sutures your surgeon may have used could have helped as well!

Anthony Youn, MD
Detroit Plastic Surgeon
5.0 out of 5 stars 30 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.