Is Drainless Tummy Tuck a Safe Procedure?

The drainless technique is based on putting stitches to "quilt" the skin down to the abdominal wall, called "progressive tension sutures" (PTS). I started using them about 2 years ago because on bigger cases like body lifts they help prevent any bleeding from one area spreading to another. I also use drains.
I keep an ultrasound in my office and saw that even with the PTS in place, there were still little collections of fluid, and the drains still drained fluid (although less).
PTS on the tummy add about 10 - 20min to the procedure and in my opinion lessen the amount of time the drains stay in. As Dr Di Saia pointed out, its all about a tight and sculpted result for you, and while they may be a nuisance for a few days, I feel drains are worth it.

The no drain tummy tuck has continued to increase in
popularity over the past several years as surgeon have gained experience in the
procedure. I personally rarely ever use drains in my tummy tucks and I have
been extremely happy with the success of it.
The procedure when done correctly is just as safe as a tummy tuck with drains. The purpose of the drains is to prevent a
seroma (collection of fluid in the abdomen), the no drain tummy tuck prevents
the seroma by using a technique called progressive tension sutures.



Progressive tension sutures hold the abdominal skin in place
and avoid any space for fluid to collect.
By placing these sutures the body can absorb the fluid that is made in
the abdomen naturally as it did before your tummy tuck.



The biggest reason that I have been doing the no drain tummy
tuck is that it makes recovery from a tummy tuck much easier. Without the drains patients are able to walk
after surgery without the worry of the drains being pulled on. It also avoids the pain and discomfort
associated with the drains as they can irritate the skin where they exit the
abdomen.



Please discuss your tummy tuck options with you plastic
surgeon.

A timeless question! A link to my research (meta-analysis) on drains for abdominoplasty is posted below. Our research showed that "drainless tummy tuck with progressive tension sutures" were more effective than tummy tuck with drains in reducing seroma (fluid buildup) and reoperation rates, with no difference for hematomas or infections.
A drainless tummy tuck is gaining popularity as a safe and effective alternative to traditional tummy tucks that require drains. This innovative technique involves using specialized sutures to attach the skin to the underlying abdominal wall, closing the space where fluid could accumulate and typically requiring drains. These sutures are called "progressive tension sutures" which reduce the space between the abdominal wall and skin where seromas can occur. The result is a more comfortable recovery for patients, as they avoid the discomfort and hassle of managing drains post-surgery. Many patients also appreciate the reduced risk of infection at drain sites and the ability to resume normal activities sooner.
While not every patient is a suitable candidate for a drainless approach, the procedure has proven to be a highly effective option. Technique matters in this surgery! Your plastic surgeon needs experience in this technique, because incorrect placement of the sutures can cause major problems including contour deformities and possible need for re-operation. Be sure to consult with an experienced plastic surgeon to determine if a drainless tummy tuck is right for you!
Krishna Vyas, MD, PhD, MHSHarvard, Hopkins, & Mayo Clinic Trained Aesthetic Plastic SurgeonNew York, New York

Drainless tummy  tucks are an integral part of my procedure.  Even with drains or tissue glue there is a a 5-45 % incidence of seroma per the literature. A meta-analysis in the Aesthetic Surgery Journal, 

Aesthet Surg J. 2017 Mar 1;37(3):316-323. doi: 10.1093/asj/sjw192.

Seretis K, Goulis, D, Demiri EC, Lykoudis, EG

Prevention of Seroma Formation Following Abdominoplasty: A Systematic Review and Meta-Analysis

reviewed all the literature on this topic, and found that "preventive measures" decreased the incidence of seroma four-fold. One of the studies included in the "preventive group" that used only progressive tension sutures, from 2006, showed fluid accumulation between the sutures, detected only on ultrasound. This fluid was not clinically detectable by palpation or inspection and resulted in no need for seroma aspiration or any complication. The total amount of fluid associated with clinical complications including drainage in the other groups was greater than 80 cc, and the total amount of non-clinically detectable fluid in the progressive-tension group was always 80 cc or less. The use of drains plus progressive tension sutures did not change the amount of fluid, so there is really no benefit to using drains plus progressive tension  sutures.
The study was discussed by Pollock and Pollock, who noted that in their series of 565 patients using progressive tension sutures they never had a clinically significant seroma. When a seroma occurs, it may require multiple visits and aspirations, and if persistent, introduction of antibiotic sclerosing solutions, or reoperation to remove a fluid filled fibrous cavity. The drain opening may leave a scar in the incision or pubic mons which may become pigmented or depressed. Not having to use drains spares the patient and plastic surgeon from the chance of these undesirable events and/or outcomes.

My experience mirrors that of Drs. Pollack.  I have had no clinically significant seromas while using progressive tension sutures in the past five years or so.
Rather than use the 15-20 individually-placed sutures described by Drs. Pollock, I completely close the dead space with continuous PDO and monoderm Quill sutures. These sutures effectively reduce the dead space to almost nothing, so even the small amount of fluid that might collect between the sutures, cannot create any significant seroma. Using running Quill sutures allows relatively rapid dead space closure as no knot-tying is needed. The umbilical location is confirmed with a Lockwood flap marker before the lower abdominal closure is completed.

                                                

A no-drain tummy tuck is not more or less safe than a traditional tummy tuck in which drains are used.TBH, I am baffled that surgeons are still using drains for tummy tucks, and I surmise that they are resistant out of a fear of change. I have been performing my tummy tucks without drains for over 10 years now. Not only does this make the patient infinitely more comfortable post-op, it actually reduces complications and yields a superior result.
This technique adds just 5-10 minutes on to a traditional TT. Instead of just pulling the skin down and suturing at the incision line, the flap is sutured down to the muscle at several different points. This reduces the space in which fluid can collect to small pockets that the body can manage and absorb. This technique of tacking the skin down also allows me to give a better aesthetic result  with a funneled natural-looking indentation around the belly button. Additionally, I have seen FEWER seromas after a no-drain tummy tuck than I did when I was using drains. Tacking the flap down also evenly distributes the pressure over the entire abdomen vs just at the incision thus reducing complications of a wound opening while also allowing for the incision to heal in a very thin line.
I recommend that you continue your search for a Board Certified Plastic Surgeon who performs drainless tummy tucks. 

Hi there,
The drainless tummy tuck procedure is not more dangerous and it does not take more time in the OR. Every surgeon works at a slightly different pace in the operating room. Most tummy tucks take between 2 and 4 hours, and the progressive tension sutures take about 20 minutes to perform (we have timed it to answer this question :) ). Ultimately, the time you save and the convenience you have with not managing drains postoperatively makes the drainless technique worth it.
Phillip Dauwe, MD