Drains vs no drains, massage vs no massage, compression garment vs no garment. What is right?

I see posts that all Dr's are different on the issues of drains, messages and compression garments, why is this? I want to know why some Dr's advise it and some do not.

Doctor Answers (10)

Drains, lymphatic drainage and garment post-abdominoplasty; protocol at Toronto Visage Clinics

+2
Thank you for your question.  Many philosophies and protocols exist for #tummytucks.  Over 12 years of practice, my protocol has evolved into using drains for several days even when using quilting sutures.  I have not had one single seromas over the last 6-7 years.  I recommend compression garment for 4 weeks and I do believe - as the Brazilians do! - in lymphatic drainage starting week 2 or 3 - minimum of 3-6 sessions.  

Hope this helps!  Dr. Marc DuPere, board-certified #plasticsurgeon, #Toronto, voted TOP plastic surgeon in Toronto for 2013 by Consumers.


Toronto Plastic Surgeon
5.0 out of 5 stars 36 reviews

Drains, compression???

+2
I assume you are asking about tummy tucks,  in regard to drains and compression.
Frist, it  is important to understand there is more than one approach tothis suregery referred to as an abdominoplasty or tummy tuck.   Scientific data is the basis for surgical choices....but this is influenced by the surgeons training and experience.   There no single "right answer" and it is the surgeons responsibility to chose the safest and most effective operation..
As to your specific questions,  drains have been traditionally used with TT  to prevent fluid accumualtion,  we have described (2000) a technique that use stitiches to advance and anchor the abdominal skin flap to the underlying tissues, which eliminates the need for drains. (progressive tension sutures.or PTS)   We published a series  nearly 600 cases (2012) using PTS that proves that drains are unnecessary when PTS are used. (1 small fluid accumulation in 597 cases).  of course, drains can be used with PTS,  but we don't in our practice.
Compression garments are used by most surgeons to minimize swelling and bruising, but also (prob. more important) to provide support for comfort when muscle repair is done.
Most important is consultations with one or more surgeons certified by the Am. Bd. of Plastic Surgery.   The technique used is the surgeon's prerogative and responsibility.

Harlan Pollock, MD
Dallas Plastic Surgeon
3.5 out of 5 stars 3 reviews

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So many questions about tumy tucks.

+2
It is easy to be confused about post op care because there are so many ways to "skin a cat".  Each doctor may do the procedure a bit differently, and then, each may have preferences as to post op regiment.  Many times there is no "right or wrong" answer. 

What is important I think, is that you settle on a board certified plastic surgeon whose work you like and ask the doctor what the regiment is, and why it is done that way.  The doctor should be able to give you a concise answer.
 
What works best for me is drains until the 24 hour total is low, and a binder after about 5 days when the circulations is assured.  I don't do "massage" for tt.  It is also important to remember that individual cases may require a change in protocol.

Scott E. Kasden, MD
Dallas Plastic Surgeon
4.5 out of 5 stars 45 reviews

Abdominoplatsy differences

+2
Drains/no drains differences are most likely related to closure techniques. I use to utilize drains routinely with abdominoplasties but since I started using progressive tension sutures as part of my closure I have not used drains and have had only minimal issues with post op fluid collections.  The progressive tension sutures in part help to obliterate the space where fluid can accumulate under the flap postoperatively thus making the drains unnecessary.
I still use compression garments routinely on all patients where the potential for fluid to accumulate exists.
In my opinion scar massage expedites and facilitates the healing process but in patients who feel uncomfortable doing so i say they they will get the same result only it will take longer.

Paul Buhrer, MD
Annapolis Plastic Surgeon
5.0 out of 5 stars 7 reviews

Drains, Massage, Garments???

+2
There are many ways to get a good result and every surgeon and patient may need a different course of action. In general, drains may be necessary for a tummy tuck or breast reconstruction. Massage may be an acceptable practice after breast augmentation and compression garments are worn after liposuction and abdominoplasty.

Consult a Board Certified Plastic Surgeon.

Best wishes

George C. Peck, Jr, MD
West Orange Plastic Surgeon
5.0 out of 5 stars 10 reviews

To drain or not to drain

+2
Thank you for you question as you have probably heard various answers to this question if you have seen several plastic surgeons already for a consultation.  

First of all in my opinion their is not correct answer to this question.  Whether or not to use drains has to be evaluated in the context of the surgery as a whole and your particular situation.  

In my practice I typically do not use drains for a routine abdominoplasty.  The technique of progressive tension sutures, allows the abdominal flap to be secured to the abdominal wall and thus decreasing the potential space for seroma formation.  

I switched from using drains to the progressive tension method with out drains mostly for patient comfort.  The drains were always my patients biggest complaint following surgery.  Since I have stopped using them they have been much more comfortable.  

I hope this helps.  

Johnny Franco, MD
Miami Plastic Surgeon
5.0 out of 5 stars 6 reviews

Opinion

+1
Thank you for the question.

In my opinion I do believe that everyone has their own opinion towards how the patient should recover. I believe that drains, garments play a very important part in regards to healing better and faster.

Jaime Campos Leon, MD
Mexico Plastic Surgeon
4.5 out of 5 stars 137 reviews

Recommendations for drains, compression garments and massage

+1

There is a tongue-in-cheek saying that if you ask ten plastic surgeon for an opinion, you will get twelve different answers.  None of them is necessarily right or wrong.  Each of us uses our training and experience to formulate a plan and process so that we achieve good outcomes for our patients.

In my practice, I do not use drains since I started putting quilting sutures  in tummy tucks.  My patients are put in soft compression garments just to help control swelling.  Most patients prefer the garments and tend to wear them for several months, but I do not think they are necessary.  Massage seems to help minimize the 'lumps' that can occur after liposuction, but again, it is not mandatory.

Hope this is helpful.

Michael S. Hopkins, MD
Albuquerque Plastic Surgeon
5.0 out of 5 stars 40 reviews

Drains, Compression Garments and Massage following Tummy Tuck.

+1
Thank you for your question regarding conflicting physician recommendations following surgery.  You do not indicate if you are referring to recommendations following liposuction or tummy tuck, but since you mention drains, I am going to assume your question is regarding an abdominoplasty.  

There are many different techniques for tummy tucks and therefore the recovery recommendations can vary depending on the plastic surgeon.  For example, in my practice I don't use any drains following tummy tuck because with advanced progression suture techniques, there is less room for serums to form, which is why your doctor may use an external drain to keep the fluid from accumulating in the area following surgery.  Compression garments is another area where opinions vary.  If you have had liposuction along with your tummy tuck, as many patients do, compression garments can be helpful to reduce swelling in the area and also provide comfort for the patient.  Lymphatic massage can be recommended following liposuction to reduce swelling, but there can be differences from surgeon to surgeon regarding this recommendation.  The most important thing is to choose a board certified plastic surgeon with extensive experience in body contouring and one you can communicate with freely before making your decision.  At that point, you should trust the recommendation of the surgeon you have selected. 

Steven L. Ringler, MD, FACS
Grand Rapids Plastic Surgeon
5.0 out of 5 stars 26 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.