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 (16)

Tunny Tuck without Drains.

+3

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 10 reviews

Tummy Tucks and Drains

+3

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.

Steven H. Williams, MD
San Francisco Plastic Surgeon
4.5 out of 5 stars 24 reviews

Tummy Tuck Without Drainage Vs. with Drains

+2
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 18 reviews

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

+2

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.

Brooke R. Seckel, MD, FACS
Boston Plastic Surgeon
5.0 out of 5 stars 34 reviews

Tummy Tuck drainage at surgeon's discretion

+2

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?

+1
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.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 759 reviews

Drainless tummy tuck

+1
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.

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.  


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

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

Pablo Prichard, MD
Phoenix Plastic Surgeon
5.0 out of 5 stars 28 reviews

No-Drain Tummy Tuck, seroma, and swelling

+1
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 10 reviews

Swelling with no-drain tummy tuck

+1

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.

Derek J. Shadid, MD
Oklahoma City Plastic Surgeon
5.0 out of 5 stars 7 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.