Drains vs no drains, massage vs no massage, compression garment vs no garment. What is right?
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Different post op routines for the same tummy tuck ?
Your right, We as plastic surgeons all have different routines for post op management. There is really no right or wrong answer. Many of the differences are a matter of style.
Most docs leave drains as a safety precaution, while some are trying to quilt the abdomen and avoid them completely. I don't think anyone would object to massage but many find it unnecessary.
In my own practice drains or not will depend on the size of the patient and the extent of the surgery. I don't generally recommend massage but I have no objection to it after an appropriate healing time. I am a big fan of Spanx for post operative compression.
I think the key is to like and respect the surgeon you choose. Minor variations in post operative management will likely make little difference.
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
Drains, lymphatic drainage and garment post-abdominoplasty; protocol at Toronto Visage Clinics
Hope this helps! Dr. Marc DuPere, board-certified #plasticsurgeon, #Toronto, voted TOP plastic surgeon in Toronto for 2013 by Consumers.
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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.
So many questions about tumy tucks.
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.
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.
Drains, Massage, Garments???
Consult a Board Certified Plastic Surgeon.
To drain or not to drain
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.
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.
Recommendations for drains, compression garments and massage
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.