I have been researching the different techniques used for abdominoplasty and would like to get the the opinion from a PS's point of view on the 'no drains, no pain pump' technique on a full TT? From what I've researched it has a much faster recovery time as well as minimal pain after surgery. Is this technique a proven one and how long have PS been performing it? Thank you.
What is Your Opinion Regarding the 'No Drains, No Pain Pump' Abdominoplasty Technique?
Doctor Answers 14
No Drains, No Pain Pump Abdominoplasty
Both drains and pain pumps are optional in abdominoplasty. What an individual surgeon does is based on experience and personal preference. Both drains to suction the flap tight and hold it to the underlying tissues and placing multiple rows of sutures to hold the flap against the underlying tissue work well. It is my experience that both work well and have essentially the same type of problems. There is really no advantage of one over the other. I personally use drains as I have seen less fluid collections with using them and using the sutures lengthens the anesthetic time. Pain pumps have significant theoretical benefit, but I have found them more of an inconvenience than benefit. Almost all of my patients do well with minimal pain meds which they stop using in 2-3 days. The only other time of discomfort is in 5-8 days when you are walking bent over and your back starts aching. No pain pump will control this. All of these options are quite old, but there is a new topical anesthetic that can be put in the wound to control pain for several days.
Comments on the "No drains, no pain pump abdominoplasty technique."
First of all, describing use (or no use) of a drain and/or a pain pump as a "technique" is a bit of a stretch. For example, I use below-the-skin dissolving sutures on most of my surgical procedures, as it avoids crosshatch marks and the discomfort of suture removal. I believe this type of closure yields a superior scar in most situations, which is why I choose to use it. This method of incision closure could be called a technique, but to describe my tummy tuck as the "No stitch abdominoplasty technique" would be disingenuous as well as incorrectly implying that this is somehow a bona fide distinguishing difference between my method of incision closure as compared to other plastic surgeons. I'd rather just tell my patients that I close all of my incisions really precisely and take pride in the good scars that this attention to detail yields, rather than describing it as a "technique" that makes it innately "superior" to all others!
The same applies to use of drains or pain pumps. I actually use a long-acting local anesthetic injection into the muscle sheath where I place my muscle-tightening sutures, as this helps reduce post-operative pain and muscle spasm from this standpoint. I also inject the incision areas, and when I use a drain, the drain exit site(s). Most of my patients have very little "pain," and use little narcotic medications, but then I also have careful surgical technique, and use anti-inflammatory and muscle relaxing medications for my patients in addition to simply covering the pain with narcotics.
Many surgeons use drains; others do not. To describe use as "bad" and non-use as "good" is meaningless--let's compare subjective patient pain responses post-op, return to activity and work status, and final cosmetic results. These are significantly more important than use of drains, pain pumps or not!
So choose your surgeon based on his/her results, and realize that those results are a culmination of training, experience, and prior patient outcomes, NOT a choice to use or not use a drain, pain pump, suture technique, or other such issue. I know patients worry about pain, some more than others, and that IS a very real and important concern. But a much more important one, IMHO, is whatever your chosen surgeon does to achieve the results you desire.
Two horns do not make a symphony. Neither do these two "techniques" make a fabulous result! Choose your surgeon based on results, not technique! Don't get me wrong--careful technique IS important, but in every step and component of a surgical procedure, not just two. Best wishes! Dr. Tholen
Drain or no Drain with abdominoplasty surgery
There is no right or wrong answer to this question and every technique will not be correct on every patient. The use of progressive tightening sutures has been well established and many plastic surgeons feel confident in not placing drains. As far as a pain pump, also a personal decision. In my opinion they help tremendously and help get my patients out of bed the night of surgery and walking around. This will reduce the chances of DVT/PE.
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No Drain Tummy Tuck
The No Drain Tummy Tuck has great results by surgeons who know how to do it. However, it is not the most important part of a tummy tuck. The Pain Pumps work well but there are other ways of reducing discomfort also.
The no drain no pain tummy tuck
Tummy tuck without the use of drains has been our technique for ten years and running. Our patients do get up quicker and feel better. We also don't use pain pumps, and again the recovery experience is faster and more pleasant without. Proven yes, without a doubt.
No drains no pumps in good hands is excellent technique/ no drenajes no bombas en buenas manos es exceelente tecnica
i have been doing it since several years without any big complication exception seroma, the secret it is in doing a good coagulation and coaptation trough several internal coapting sutures than selling both fascies, another exception could be a big complete circumpherential TT
las excepciones serian una completa TT circunferencial, y se forman algunas veces seromas, el secreto esta en hacer varios nudos internos que sellan ambas fascias la profunda y la superficial
Exparel and progressive tension suture tummy tuck
No drains, no pain pump tummy tuck
Many surgeons perform their tummy tucks with no drains, either by using quilting sutures or with tissue glues or sealants. Quilting sutures can give an odd appearance with dimpling on the skin surface which can upset patients.
Pain pumps reduce surgical pain by giving local numbing medicine into the area where the 'muscles' (fascia) are tightened, so why have surgery without the pain pump?
In our practice, use of these measures has decreased or eliminated the usage of drains for less invasive tummy tucks and for full tummy tucks alike.
In any event, as with everything else, 'times they are a changin'", with the patient benefiting!
No Drains, No Pain Pump, Tummy Tuck Surgery?
One of the realities in the field of plastic surgery is that if you were to ask 10 plastic surgeons for their opinions, you would receive at least 11 different different In(and ver any st androng/adamant) opinions. This is simply the nature of our discipline.
If you are looking to have tummy tuck surgery performed, I think you will be best of spending your energy choosing the plastic surgeon who you feel can most likely achieve the results that you are looking for safely and consistently. The exact technique used, use of drains or not, use of pain pump or not etc. are not nearly as important considerations.
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