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 (15)
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.
Tummy Tuck Without Drainage Vs. with Drains
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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 tuck
The use of drains can lead to certain problems, though. Patients often report irritation and discomfort with the drain itself, annoyance regarding limitations on movement, and the need to empty the drains two to three times per day. Drains also carry the risk of creating infections, making unnecessary scars, and can also technically malfunction.
A drainless tummy tuck avoids these problems by using the progressive tension suture technique. 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 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 it. 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.
Drains and Tummy Tucks
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.
Pablo Prichard, MD
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.
Swelling with no-drain tummy tuck
There is going to be swelling of the tissues with either a normal tummy tuck with drains or one done without drains. I have done a tummy tuck both ways but have switched to the no-drain tummy tuck for the last 8 years. There is initially slightly more swelling of the lower abdomen with the no-drain technique. In addition, there are often small dimples in the skin where the internal quilting sutures are pulling on the skin. There is less pain, however, with the no-drain patient because they do not have drains pinching their skin. After 3-4 weeks, the swelling and appearance of the no-drain tummy tuck patient has equalized with that of the normal tummy tuck patient. It will take both patients a good 3-6 months to completely resolve the swelling.
Tummy Tuck With No Drains
Smaller tummy tucks can be done without drains, and some believe that using a certain type of sutures called PTS sutures may minimize fluid collections. This is really based on surgeon experience and preference. Swelling is a highly variable process that is also very individualized. The use of drains really does not affect swelling after surgery.
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.