The drainless and drain TT - what are the advantages between them?

Doctor Answers 10

Drainless vs drain Tummy Tuck

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The traditional procedure for a tummy tuck involves using drains. As plastic surgery residents training more often than not utilizes the most conservative techniques. As such using a drain generates suction force which draws of the fluid which can accumulate following a tummy tuck. However, leaders in the field of plastic surgery in Brazil pioneered the technique of a drainless tummy tuck by altering the procedure itself. The abdominal wall is made up of many layers. One of those layers is called Scarpas fascia layer. It has been shown to contain lymphatic channels which can aid in the drainage of any accumulated fluid following the tummy tuck procedure. By liposcutioning below this layer and thinning it out, the Scarpas layer can be left intact and act as an internal sump drain for the abdominal wall. Thus the advantages for drainless vs drain tummy tucks are less about the use of a drain and more about the specific modifications of the procedure itself which can make improving patient comfort, in the post operative period, more attainable. Drains can also leave extra scars at exit points and are sometimes placed in the pubic area or Mons area, which can be very uncomfortable at best and painful at worst.

The drainless and drain TT - what are the advantages between them?

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Drains and progressive tension suturing - PTS (quilting stitches) are both acceptable means of addressing the risk of fluid collection formation.  With every method, there are pros and cons.  Although the presence of drains may be a slight nuisance, it does a great and time-tested job of reducing the risk of collections.  The benefit of PTS is that you avoid the drains but your procedure may take longer and there may be more postoperative pain. Regardless, be sure to consult with a board certified plastic surgeon who is experienced in the procedure you're looking for.  Good luck!

Zachary Farris, MD, FACS
Dallas Plastic Surgeon
5.0 out of 5 stars 23 reviews

Drainless Tummy Tuck vs. Drains

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In my 27 years as a plastic surgeon, I have heard so many times from my patients that the worst thing about a tummy tuck is, " the drains". So, when I heard a lecture by Dr. Harlan Pollock in Dallas about how he had come up with a way to avoid drains, I was all ears. Now, some 8 years later, I have much happier patients. Drains may be good for treating seromas, but I cannot find a credible paper that says drains prevent seromas. My own seroma incidence is slightly higher in the drained population than the undrained. As Dr. Pollock asked me years ago, "Have a little faith. It will work for your patients". He was so right. Thank you, Harlan Pollock, for your drainless tummy tuck innovation.

Christopher S. Jones, MD
Indianapolis Plastic Surgeon
5.0 out of 5 stars 11 reviews

About the Drainless Tummy Tuck

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The purpose of applying #drains to a tummy tuck is to release extra fluid that may otherwise accumulate under the skin, fat or muscle following surgery. Patients generally find this annoying and uncomfortable and they can impede mobility and therefore slow aspects of #healing. Over the years, surgeons have improved procedures and found ways to eliminate the need for these #drains in a variety of operations; including #tummy #tuck or #abdominoplasty.

I have found that most of my patients do very well with the exception of those have large areas of liposuction or lipo-abdominoplasty.  I may use drains on a case by case basis for these patients. Also, a newer option now can include the use of tissue #glue to adhere the a#bdominal #skin to the #muscle; eliminating any space that previously required a drain.

If you go to a plastic #surgeon who uses drains, or if your situation requires drains, they usually stay in 3-5 days but may be required to remain in longer. The most important decision to be made before performing any surgical procedure is determining whether you are an ideal #candidate. Your board-certified plastic surgeon will recommend the type best suited for you during a one-on-one in-person consultation. Also, another element to a satisfying result of your procedures are realistic #expectations.

Jed H. Horowitz, MD, FACS
Orange County Plastic Surgeon
4.9 out of 5 stars 116 reviews

Many patients enjoy not having drains following a tummy tuck.

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I feel that my patients are very excited to not have any drains following their tummy tuck.  It allows for less discomfort and avoids the hassle of having something attached to them following their procedure.  The addition of progressive tension sutures or quilting sutures does not add significant time to the procedure and post operative seromas or fluid collections have been rare.

Sanjay Grover, MD
Orange County Plastic Surgeon
5.0 out of 5 stars 245 reviews

To drain or not to drain

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The use of drains or a drainless technique is largely down to your surgeons preference and whether they trained in an environment which used the or not. I will also sometime use drains based on findings and decisions during surgery, and warm patients undergoing drainless techniques that I might still place a drain if I think there might be an increased risk of fluid collection, however progressive tension sutures certainly reduce this risk.

Anthony Barabas, MBBS
Cambridge Plastic Surgeon
5.0 out of 5 stars 20 reviews

Traditional v drainless tummy tuck

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Hi - it is becoming more common for plastic surgeons not to use drains after surgery with changes in the surgical technique for tummy tuck. By leaving a layer of fascia on the abdominal wall and by using progressive tension sutures we can reduce the need for drains after tummy tuck. Discuss both options with your surgeon. 

Pros and cons of drains and no drains in abdominoplasty tummy tuck (TT) surgery

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I have not used drains for tummy tuck surgery for over 14 years and have never regretted it.

Drains cannot always stop haematoma or blood clot accumulation but they can be painful and a source for bacteria to get into  the wound. 

I leave a thin film of fat over the deeper abdominal wall muscles and if undermining is cautious at the upper outer end of the wound the lymphatics are less damaged and so the incidence of seroma or fluid collection drastically reduced even without quilting sutures though I do sew the downward advanced skin and fat to the underlying muscles to reduce tension in the skin wound and so improve the chances of the best scar. I do advise a compressive garment to be worn day and night (apart from during washing) if possile for  6 weeks after surgery.

I hope that that is helpful.

Best wishes

Tariq Ahmad, MBBChir, FRCS(Plast)
Cambridge Plastic Surgeon

Advantage a drainless tummy tuck

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The drainless tummy tuck has several advantages and really no disadvantages in my opinion. By using progressive tension sutures or quilting sutures, the skin flap can be effectively fixated back to the abdominal wall during the surgery. If done properly, the quilting sutures will prevent fluid from accumulating between the skin flap and the abdominal wall, thus eliminating the need for drains. I have been performing the drainless procedure for 6 years now and have only had a few seromas that required aspiration or treatment. Suprisingly, I have had significantly fewer seromas than when I used drains (and took them out too early). Patients love not having drains, it lowers the already small risk of infection, and psychologically patients deal with the recovery better. I also think that the progressive tension sutures offload the tension on the skin closure resulting in slightly better scarring.

Wm. Todd Stoeckel, MD
Raleigh-Durham Plastic Surgeon
4.9 out of 5 stars 90 reviews

Drainless TT

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The obvious benefit of a drainless TT is not having drains in the post-op period which can be uncomfortable.  However, I allow my patients to shower with drains starting 24 hours after surgery.  My decision on whether or not drains are needed is based on how much fluid I feel will accumulate after surgery.  Typically, if I need to do a larger volume of liposuction at the time of TT, I will put a drain or two in.  If not, I will do a progressive tension closure and not place drains.  Every patient is a different case.  I hope this helps.

Guy Cappuccino, MD
Mount Airy Plastic Surgeon
5.0 out of 5 stars 105 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.