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What Are the Advantages of Using PTS Sutures for a Tummy Tuck Procedure?

Doctor Answers (8)

Progressive Tension Sutures are great in tummy tucks.



They do several very good things.  1)  They tighten the upper abdomen.  2)  They markedly lower the risk of a seroma.  3)  They decrease the tension in the scar.  4)  They often eliminate the need for drains.

Manhattan Plastic Surgeon
5.0 out of 5 stars 9 reviews

Stitching techniques in tummy tucks


Dear Alexandra

By PTS sutures, I presume you mean Progressive Tension Sutures (also known as quilting sutures). The principle behind using these internal stitches is twofold: firstly, they reduce the "deadspace" or cavity, limiting how much fluid can build up in the wound area; and secondly, because of the tension they spread over the whole of the abdominoplasty flap, they avoid all the strain being put on the area of the scar above the pubic hair (which is what happens in a traditional tummy tuck). This then minimises the risks for wound healing problems and scar breakdown, and in addition the PTS sutures can be used to sculpt a more attractive shape to the abdomen.

I hope this answers your question!


Marc Pacifico, MD, FRCS(Plast)
London Plastic Surgeon
5.0 out of 5 stars 12 reviews

PTS or drainless tummy tuck

PTS has helped resolve one of the lingering problems associated with recovery: the use of surgical drains. After the traditional form of abdominoplasty is complete, patients are typically fitted with small, thin tubes that pass through the skin. For about one to two weeks following surgery, these tubes are used to drain any of the excess fluid that accumulates in the potential space between the skin / fat and the muscle left behind by the surgery and ensures a safe, speedy recovery. Without drains, the fluid that naturally collects in the wound can stop the underlying fat and muscle tissues from coming together and properly healing.

When using PTS, the first part of surgery remains the same: creating a horizontal abdominal incision, strengthening the weakened or separated internal muscles, removing excess skin, liposuction and repositioning the remaining tissue. Then, PTS bypasses what would usually be the next step: placing drainage tubes. At this point in the procedure, your surgeon instead administers a series of carefully placed stitches that close the cavity usually left open and tended with drains. These tissues are then able to heal without any significant amount of fluid accumulation interfering with the process.

While using PTS to create a drainless tummy tuck may take the surgeon slightly longer to perform, the benefits of the approach are well worth it. Not having drains in place makes the recovery process more comfortable, cost effective, and less painful. There is also a greatly lessened risk of infection, additional scarring, and healing complications. When PTS is used, the tummy tuck heals more quickly and recovery isn't as difficult for the patient.

However, not everyone is a candidate for this type of surgery. For example, thinner patients may benefit more from the use of drains than others. When PTS is used, thinner patients are at a higher risk for developing permanently dimpled skin due to the stitching technique inherent to the no drain approach. Consequently, it is necessary for every patient to be carefully assessed during their consultation.  

Jerome Edelstein, MD
Toronto Plastic Surgeon
5.0 out of 5 stars 66 reviews

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Drains and Tummy Tucks

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 28 reviews

Progressive Tension Sutures for Tummy Tuck


This is a technique I commonly use for my tummy tuck patients and DIEP flap breast reconstruction patients, where abdominal tissue is harvested to recreate a breast.  


It helps remove the drains more quickly by carefully placing sutures to approximate the abdominal soft tissue to the underlying muscle.   The key is placing the suture such that they do not result in skin dimpling or contour deformities.


With proper use, I have been able to remove my drains in about half the time compared to without Progressive Tension Sutures.


I hope this helps.


Dr. Gill 

Paul S. Gill, MD
Houston Plastic Surgeon
5.0 out of 5 stars 39 reviews

Sutures in Tummy Tucks


PTS sutures can mean Progressive Tension Sutures which are placed between the skin/fat layer and the deep fascia layer progressively as the excess skin/fat is pulled inferiorly and are designed to prevent space between the two layers, thus reducing the risk of fluid accumulation. Drains, when used properly, and other methods also do this. There is another similar sounding suture, the PDS suture that is frequently used in Tummy Tucks and other procedures to improve the eventual scar. These sutures dissolve very slowly and maintain their strength for many months, thus supplying strength to the wound until the body builds enough strong scar to keep that scar from spreading and looking ugly. The reasons for using both these sutures are what we are all striving to improve. If your surgeon does not use either, you might ask how he/she accomplishes the goal of each.


Robert T. Buchanan, MD
Highlands Plastic Surgeon
5.0 out of 5 stars 4 reviews

PTS Suture Technique


I am assuming you are referring to progressive tension sutures when you asked about PTS.  This is a technique were sutures are strategically placed to eliminated the empty space (ie dead space) that requires healing after a tummy tuck.  Some surgeons advocate for this techniques while others feel it does not add that much to the procedure or the patient's postoperative experience.   It is one of the techniques available to plastic surgeons to help their patients.   Please see a board certified plastic surgeon in your area to learn more about your options.

Dr. Basu

Houston, TX

C. Bob Basu, MD, FACS
Houston Plastic Surgeon
4.5 out of 5 stars 123 reviews

Progressive Tension Sutures and Abdominoplasty


Dear AlexandraLynn,

I assume that you mean Progressive Tension Sutures and there are a number of reasons to use them in an abdominoplasty.  First, they close up the "dead space" between the two layers in an abdominoplasty diminishing the risk of a seroma.  Two, they distribute the tension on the abdominal flap more evenly.  This means less stress on the incision closure site and hopefully a better final scar.  Third, the PTS allows the surgeon to shape the abdomen such as creating a subtle midline depression.  As far as completely replacing the need for drains, there remains a lot of controversy on this claim.  Just for the record, I do use progressive tension sutures and I still like to use drains.  Hope this helps. 

Herluf G. Lund, Jr, MD
Saint Louis Plastic Surgeon
4.0 out of 5 stars 18 reviews

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