Drainless tummy tuck works well
This technique uses sutures to "quilt" the skin and fat back onto the muscle, with 12 to 18 stitches on average. This eliminates the potential space for fluid to collect in and thus the need for drains. It also stops the skin and fat layer from sliding around on the muscle and so decreases the pain. There is a learning curve for the surgeon ( I used stitches AND drains for several cases and quit the drains after seeing no output.) The technique was first described in 2002 but did not catch on until a second paper detailing its use in many more patients was published; an audience survey at a large breast and body meeting recently had about 35% of the surgeons there going drainless. I have not used a drain in tummy tucks since August 2012 and have actually fewer complications than before and far less pain complaints postop.
Internal sutures are placed to secure the skin and fat to the muscle. If enough sutures are placed, the drains can be eliminated but there are risks including dimpling of the skin and strangulation of the subcutanous tissues if they are not placed perfectly. They do add to the operative time too but less so with experience. I have eliminated one of the drains in my tummy tucks using these sutures in the upper abdomen but usually use a single smaller drain below and find that there is still fluid collected in that drain. The patients who have gone drainless have done well however and I cannot recall seeing a seroma in my practice with either technique in at least 7 years, so both work. I still like the feeling of "insurance" using a drain in patients at higher risk of seroma. For example, I am personally less inclined to "go drainless" in a massive weight loss patient with tremendous laxity, mobility, thinning and stretch marks of the skin.
Steps for Drainless Tummy Tuck
The procedure is identical to tummy tuck performed with drains except that the space between the fat and underlying muscle is sutured closed, thus eliminating the need for drains which normally would drain this space. A study presented at the 2016 ASAPS meeting showed clearly that the Drainless technique can be carried out safely when performed by a surgeon who is experienced using this procedure.
The Drainless technique has been used for years at Pratt Plastic Surgery with excellent results and countless happy patients when used with patients having a BMI less than 30.
Plastic surgeon performing tummy tucks for more than half a century years have used drains. Recently a technique has been slowly becoming more popular using Progressive Tension Sutures (quilting stitches) to attach the superficial skin/fat to the deep muscle layer below to prevent fluid accumulation that a drain would otherwise remove. It is not fool proof (nothing is), takes a bit more time under anesthesia to place these stitches and a girdle is generally worn immediately but a drain-less Tummy Tuck seems to work well. Patients tend to like this as there is no drain care and they can shower earlier. There may be slightly more swelling, more of a chance for seroma in some but in the long run (after 1-2 months) no difference in the swelling of those with and those without drains. On the other hand use of drains in my experience is a quicker operative time, early on prevents seroma and minimizes bruising, easy and painless to remove postoperatively, no need to wear the elastic garment/girdle until the drains come out in my practice.
Progressive tension sutures use absorbable sutures that close any cavities inside your body that are created after tissue removal, minimizing the risk of seroma/hematoma and making drains unnecessary. It can reduce the risk of infection and your recovery tends to be faster than if drains were used. However, thinner patients may require drains. That's why you have to get a consultation to see which technique would be best for you.
Thank you for your post. Whenever there is a potential space in your body, your body tends to fill that space with serous fluid (the yellow type of fluid that also comes out of a 'weeping wound'. This is similar to when you get a blister: the layers of skin separate and fluid is deposited in to the space. In a tummy tuck, the space is in between the skin/fat layer and the muscle layer. Most surgeons will place a drain to remove this fluid while your body is secreting it until the fat layer grows back together with the muscle layer. At that point, no more fluid is secreted into the area, because there is no more space for fluid. The length of time that this takes varies from patient to patient. Some patients heal much faster, thus the layers seal together much faster. Also, the more twisting motion you have in your belly area, the slower the two layers grow back together because they are moving in relation to each other. The fluid coming through the drain can be initially dark red, and eventually clears to pink then yellow. This is because it takes just a little bit of blood to make the fluid dark red. Also, initially, there can be a large amount of fluid (few hundred cc's in the first day is not out of the range of normal) and this should slow down substantially over next few days. Once the fluid slows down to the amount that your surgeon is comfortable with (usually 25-50 cc in 24 hours) then they will be pulled. There is minimal discomfort in pulling the drain in most patients.
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
Thank you for the question.
Although many surgeons have their own opinions about this, in my opinion I don't perform any drain less tummy tucks, I believe the drain is essential for the recovery process and prevents any infections from forming because of the body fluids that build up after the procedure. This also helps your body heal faster and smoother, giving you greater results.
How is a drain-less tummy tuck performed?
The dissection and muscle repair are done as usual, however the closure is done with progressive tension sutures which attaches the skin and fat to the abdominal wall as the closure is performed. this prevents the formation of seromas which is the most comon complication after tummy tuck. It takes longer to close , but the results are worth it.
Progressive Tension Suture method for drainless tummy tuck
The Progressive Tension Suture (PTS) method uses internal stitches to tack down the flap. It has several benefits including less tension on the scar so it can be low and heal nicely, sometimes better definition of the abdominal contour, and less tendency for fluid accumulation. Many surgeons who use the PTS method do not use drains, but I still prefer them for a day or 2. Without PTS, drains may need to be in for a week or longer.
Usually surgeons who use this technique put in multiple extra sutures from the abdominal skin and fat down to the abdominal muscle wall, to make it harder for any fluid to accumulate. This may add 20% or so the the operating time, anesthesia time, etc., but otherwise the procedure is not different.
All the best.