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?
Tummy Tuck Without Drainage Vs. with Drains?
Doctor Answers 19
Tummy Tuck With or Without drains
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.
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.
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.
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No Drain Tummy Tuck
No-Drain Tummy Tuck, seroma, and swelling
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.
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.
Drainless Tummy Tucks Often have Less Swelling
We know for a fact, that when tissues are stabilized, they will heal more quickly because the initial phases of healing require that tiny blood vessels called capillaries actually grow and bridge the gap between the 2 tissues trying to heal together. When the tissues are firmly connected by sutures, this capillary connection occurs very early after the the procedure.
When drains are used, the fatty tissue beneath the skin of the abdomen needs to heal to the underlying muscle, but there if nothing is holding the tissues in place, they tend to slide across each other when you use your core muscles, such as getting in and out of bed, sitting on the toilet, and so many other activities that patients must do during the first week of their recovery. As you can imagine, the tissues have a harder time to grow the tiny capillary blood vessels across the gap between them, and often the progress that has been made is nullified by a movement that causes a shearing and tearing of these newly grown capillaries. This vessel damage is often manifested by bright red blood found in the drainage fluid reservoirs in patients who are 5-7 days out from their surgery date.
We know that delayed healing is associated with more prolonged swelling than when healing occurs without delay. Additionally, a significant number of patients with drains will develop a seroma, or fluid collection when drains are removed. The additional fluid in the tissues will obviously contribute to more swelling.
Tummy Tuck Without Drainage Vs. with Drains?
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.