Tummy Tuck Without Drainage Vs. with Drains?

Does it make a difference on swelling? I notice that people who have Tummy Tucks without drainage seem to be more swollen than tummy tucks done with. What is the difference?

Doctor Answers 18

Tunny Tuck without Drains.

Traditionally, surgeons have used drains after a tummy tuck to drain any fluid which may accumulate under the skin which has been repositioned and tightened.  We refer to this space beneath the skin as "dead space".  Basically a space without purpose, but one in which fluid can accumulate.  This fluid is usually serous fluid (clear fluid) from the disruption of the lymphatic vessels during surgery and not blood. 

Now, if the dead space is eliminated through quilt suturing of the skin which has been repositioned to the tissue underneath, there would be no place for the fluid to accumulate.  This suturing technique of the two layers to obliterate the dead space takes a bit more time in the operating room, but it works quite nicely and avoids fluid collection.  It works in both massive weight-loss patients and those who have not had significant weight changes other than pregnancy.  Not having drains brings a significant amount of comfort to the patient in exchange for a few minutes of longer surgery time.

Whether drains are used or not, there is a certain degree of swelling associated with a tummy tuck that results from a) disruption of the lymphatic vessels and b) from change in the pattern of blood flow to that part of the abdomen.  Swelling is related to fluid accumulation between the cells in the tissues and not in the dead space where the drains are placed or where the space is closed by sutures.  In conclusion, I have not found that having or not having drains makes a difference in the post-operative swelling. However, not having drains after the surgery is much more comfortable for the patient.

San Francisco Plastic Surgeon
5.0 out of 5 stars 14 reviews

Have a question? Ask a doctor

Tummy Tucks and Drains

Thanks for your question.

Tummy tucks creates a large dead space above the belly button down to the incision. Fluid can accumulate in this space. In addition, incisions used to perform abdominoplasty divide small lymphatic vessels decreasing the body's ability to return fluid from tissue back into the circulation.

Drains usually stay in from 4 days to two weeks. The drains are used to remove fluid that collects in the dead space created. When drain output is low enough (most surgeons use about ~30 cc/day as a point that indicates the drains are safe to take out).

Even after the drains are removed there will be some degree of swelling in the tissue flaps themselves because of the divided lymphatics. It takes those channels several months to reconstitute. The swelling within that tissue will last until your body has rebuilt them.

I hope that helps.

Tummy Tuck With or Without drains

Plastic surgeons have been doing tummy tucks for over 50 years and have used drains. For 20 years I used drains on all my patients, but for the last 5 years I rarely use them. Dr Harlan Pollack in Dallas pioneered and popularized a technique using Progressive Tension Sutures (like quilting stitches) to attach the skin and fat to the deep layer underneath after removing the excess and wrinkled skin. I have done this procedure now for 5 years and I have never had a fluid accumulation, which is why drains are used (however, the technique does not eliminate the risk - nothing can eliminate all risks).
Patients are more comfortable when they do not have to care for drains and they can shower earlier. There may be slightly more swelling, but it is not significant and by 1 month there is really no difference in the swelling of those with and those without drains.

Be sure to visit a board certified Plastic Surgeon who is regularly performing body contour surgery.

Paul J. Loverme, MD
Verona Plastic Surgeon
5.0 out of 5 stars 2 reviews

No Drain Tummy Tuck

I have not noticed a difference in post op swelling since changing from performing tummy tucks with drains and using the No Drain Tummy Tuck procedure.  It takes an extra 20 min in the operating room to place the progressive tension sutures which allow for closure without drains, but the added time in the operating room is well worth it. At our surgery center, we transitioned to the No Drain Tummy Tuck technique a bit more than 3 years ago and have had great success with it.  Most of our patients have liposuction at the same time as well. As a matter of fact, I'm currently collecting data on more than 400 patients who had both types of tummy tucks and the no drain tummy tuck appears to have less complications, including seromas, in our preliminary data.  In addition, not having the drains for 1-2 weeks is extremely nice for the patient, as they were the source of most of the complaints of tummy tuck patients back the drain era. 

Luis H. Macias, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 19 reviews

No-Drain Tummy Tuck, seroma, and swelling

It is certainly true that most plastic surgeons use drains when they do Tummy Tucks.  Doing the Tummy Tuck without drains is more complex, since it is necessary to eliminate the space where the fluid would otherwise collect in order to prevent a seroma.

However, doing the Tummy Tuck using the No-Drain technique has actually been shown to reduce the chance of seroma.  As one of the other doctors noted, seroma is one of the most common complications of standard Tummy Tuck, but I have been doing the No-Drain Tummy Tuck for all of my Tummy Tucks since 2008, and it has been years since I last saw a seroma after a Tummy Tuck that I performed.

One of the other answers also suggested removing the drains after the daily drainage is less than 30 cc per day, and that is certainly the standard practice.  However, I think that misses the point.  I think that often a seroma will occur after the drain is removed if there is still a space and lack of attachment between the overlying Tummy Tuck flap and the underlying abdominal muscle.  So even if the amount of drainage every day is lower, a seroma can still occur once the drain is removed.  When I used drains for Tummy Tucks, I often saw seroma occur even if the drain was left in place for three weeks, and the risk was higher if the drain was removed sooner than three weeks.

Swelling is just a descriptive term, and can be the result of seroma as well as healing of the tissue.  Some swelling occurs with any surgery, and I don't think it is any greater whether or not drains are used in Tummy Tuck.  I would say that it is probably very hard to evaluate the amount of swelling from online posted photographs, taken using different photographic techniques at different focal lengths, different lighting conditions, and different times after surgery.

James Nachbar, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 13 reviews

Drainage after Tummy Tuck reduces chance of fluid accumulation and swelling beneath the skin

I usually place drains beneath the skin after a tummy tuck. The drains remove fluid and blood that accumulates in the first 24 hours after the tummy tuck.

I use drains, because if the fluid does build up after surgery and a drain is not used to remove it, you can develope a seroma which is an accumulation of fluid that not only causes swelling, but also has to be removed by needle aspiration. This prolongs recovery and can produce longer swelling. Seromas can become infected and harm the final aesthtic result.

Long-term swelling after tummy tuck (6 weeks to 3 months) is not likely caused by failure to use a drain. More likely, long-term swelling is caused by failure to remove enough skin and/or fat during the tummy tuck.

Tummy Tuck drainage at surgeon's discretion

To drain or not to drain is at the surgeon's discretion as there is no concensus. The majority of surgeon's drain, some for just a couple of day, some for weeks. Some try to suture the cavity closed thus obviating the need for drainage. The main purpose is to prevent small hematomas or seromas from forming. It usually does not prevent large bleeds from occurring and the amount of swelling should be less as bruising (which contributes to swelling) should also be less.

However, it may be that those situations that demand drainage because of above average oozing or bleeding are the ones that will produce more swelling. The usual mantra is when in doubt, drain.

Robin T.W. Yuan, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 8 reviews

Tummy Tuck Without Drainage Vs. with Drains?

Thank you for the question. It is extremely common to receive different opinions from different plastic surgeons about the best way to treat a specific “problem”. Each plastic surgeon may have his/her opinion that is based on their specific/unique education, experience, and personal preferences. Their opinions may also be shaped by unfavorable results they have encountered in their practices.
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.

Tummy Tuck Without Drainage Vs. with Drains

Each surgeon has his or her preferences regarding surgery. Drains are designed to ensure that there is not fluid buildup. The surgical technique should be based on the surgeon's preferences, the scope  of the surgery that you need, and the specifics about you. Consult with 3 board certified plastic surgeons to understand your options, and choose the one that best meets your needs/objectives.

Kris M. Reddy, MD, FACS
West Palm Beach Plastic Surgeon
4.5 out of 5 stars 21 reviews

Drainless tummy tuck

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.

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.