Is Drainless Tummy Tuck a Safe Procedure?

According to answers posted on this site it seems that performing a tummy tuck without a drain is seldom recommended. There was a similar debate concerning drains after a facelift many years ago, and again surgeons divided into those that did drain and those that did not.

Today, very few surgeons consider using a drain in a facelift procedure, and my feeling is that in tummy tuck, in the future, few surgeons will continue placing a drain. In our practice for the past nine years, we have stopped using drains in our tummy tuck patients and have not suffered a single problem or complication from not doing so. Really.

Omitting the drain actually represents a cost savings which can be passed on as a lower overall cost of the procedure. Changes in surgical practice should be adopted slowly and with care. However, there are an increasing number of surgeons who have reduced or eliminated the need for drains in abdominoplasty safely, and to the benefit of all.

Best of luck,

peterejohnsonmd

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 procedure you are describing usually goes by the term "progressive tension suture" abdominoplasty because of the sutures that are placed inside, which distribute the tension instead of placing it all at the edge. The other benefit is that the internal stiches close off the space where fluid accumulates. The first one to report this was Dr. Harlan Pollock, who has been doing it without drains with good success for many years. I had also started doing something similar, and noticed that output in the drains was greatly reduced but I didn't go so far as to eliminate them completely. However, we are now able to get them out much sooner than before so I highly recommend the progressive tension technique. In my opinion the results are better, and the recovery is faster.

Drain less Tummy Tuck operations are performed by Plastic Surgeons who use a quilting technique. In this procedure, multiple sutures are placed between the muscle and fat layer to quilt the skin like a down comforter. It requires a lot more time in the OR and needs an experienced physician. We perform more than 100 Tummy Tucks a year and still use drains. Our complication rate with drains is extremely low, so I see no reason to add the time to the procedure.

While the idea of no drains after surgery is appealing, there are down sides. A local seroma, or fluid collection, is very difficult to drain or remove. Quilting can cause irregularity of the skin if not done evenly. Make sure you see pre and post op photos from the MD you discussed this with to ensure a good result.

Good Luck!

Joderbug,

I would venture to say that very few plastic surgeons perform tummy tuck surgery without drains at this point in time. The concept of "drainless" tummy tucks has been proposed by the aforementioned father and son team (Pollack and Pollack), however, even they are not so dogmatic as to say drains are never necessary, only that the use of drains and quilting sutures together has no added benefit. They do state that the use of progressive tension sutures increases operative time. The increase in time might be small, but it doesn't take long to form a blood clot in the legs when under anesthesia and we do know that longer operations present higher risks of blood clot formation. So, you may pick which scenario best fits your personal feelings. Good luck!

In spite of new techniques developed to try and eliminate postop seromas and the use of drains, seroma formation remains a problem without drains. I continue to use drains because of this.

The vast majority of Plastic surgeons wish they could do their tummy tucks without drains AND 100% of our patients wished we could do it this way.

Over the years, multiple colleagues came with various suggestions on how to prevent the use of drains or be able to remove them a day or two after the operation. The longest claimant in this series was by a father / son surgical team from Dallas who have published several papers on the use of space obliterating "quilting" stitches between the skin/fat flap above and the tummy muscle lining below claiming that doing so does away with the need for drains.

I believe most of my colleagues and I have tried this method. As far as "saving time in the OR" -- that is utter nonsense since placing the drains takes a fraction of time compared to what it takes to place the sutures. I have found out that it does not work consistently and stopped using it. I suspect most of my colleagues feel the same way.

I would much rather the fluid produced be promptly removed and allow for a faster adhesion of the skin/fat flap than for fluid to form which prolongs this adhesion and present the potential for infection and potential abscess formation.

I hope this was helpful.

I personally would not do a TT without drainage because of the risk of a seroma. Interestingly though, about 4 years ago I switched from using 2 rather large drains to using only 1 which is about the size of a piece of spaghetti and just slides out painlessly. The seroma rate has gone to essentially zero with the new system and it is very well tolerated.

Don't let the drain issue be the deciding point on where to have your tummy tuck done. Go with the doctor who is going to give you the best looking result.

We perform all of our tummy tucks with a drain. In general, the drain allows fluid to be removed rather than reabsorbed by your body. There are ways to do tummy tucks without drains, but it would have to be an ideal candidate (fairly thin) and then the patient would need to wear some compression garment to help prevent fluid accumulation.

The drain should not be your foremost decision. Make sure you look at enough photos (especially of non-drain tummy tucks) and make sure you are comfortable with the surgeon, the operating room and the staff.

Dear Joderbug

A drainless tummy tuck is a very acceptable procedure and safe in the right hands. I have done them at times myself but most times do use drains because I also use an implantable pain pump that delivers local anesthetic into the wound for several days

Don't let the drain be your only consideration but look at the surgeons results and ask to speak to a patient or two if possible. Even without the drains you will have several days where you will be at the very least out of commision.

Good Luck

Steven Schuster MD