Drainless Tummy Tuck: Drain Away the Confusion
An abdominoplasty is a very popular surgery to undo damage done to the abdomen by pregnancy. Excess skin is removed, excess fat can be sucked away with liposuction, and those displaced six-pack muscles (aka rectus diastasis) are restored to their normal anatomic position thus creating a flat and more youthful abdomen. The recovery after a tummy tuck and potential complications are not insignificant, and surgeons are always looking for ways to improve safety and speed recovery. One complication that can occur after a tummy tuck is called a “seroma.” A traditional or “full dissection” tummy tuck creates a lot of raw space internally, and fluid can build up in that space potentially requiring future drainage and even surgical correction. One new way to counteract fluid collections is to use sutures to plicate or pin the abdominal flap to the deep, abdominal wall fascia thus limiting the space for fluid to collect. Some surgeons have subsequently used this technique to avoid the use of drains altogether. This is a reasonable approach under certain conditions. If you are thin and do not have a lot of excess fat, a drainless approach is fine. As soon as you add a larger patient (and thus larger tissue resection) to the mix or add liposuction, there is intrinsically more fluid and potential drainage involved, and thus a drain free approach is not prudent.
Several recent prospective, single surgeon studies have examined drainless abdominoplasty and have documented a lower seroma rate. The clinical significant of these limited studies remains to be determined. I have had one seroma after an abdominoplasty since 2007 using approach first popularized by Ted Lockwood and later a Brazilian surgeon named Saldhana. It is called a “lipoabdominoplasty” or sometimes limited dissection abdominoplasty. Rather than create a large, continuous raw space, the dissection is limited to a a small vertical area overlying the rectus muscles for the sake of the muscle plication. Laterally, rather than dissecting up to the costal margins, liposuction is used to create a discontinuous dissection. This allows for flap mobilization but leaves vertical fibrous bands in place thus negating the need for sutures. Adding liposuction to the equation (which I do > 95% of the time) adds an element of sculpting that is otherwise missing in a standard tummy tuck. I still use drains with this approach, but they are rarely in more then a week or two at the most.
In my humble opinion, a well-executed lipoabdominoplasty is clinically superior to a drainless approach. It allows for better contouring and the seroma rate and overall complication rate is as good or better. Drains are annoying, but they do not slow recovery in any way and if anything speed healing and resolution of excess fluid buildup particularly when liposuction is done.