Drains vs drainless for tummy tuck with muscle repair? What is more risky?

Question

I have to option to do my traditional tummy tuck (& muscle repair) with or without drains? Will I get a better result if I do the drainless TT (it's more expensive)? Will my recover be easier if I do the drainless? Is the drainless more risky? Where does the fluid go?

Luis Macias, MD, FACS · Answer

Recovery will be very similar, except that you will not need to deal with the difficulty of managing the drains (draining them daily and keeping a log, they can get caught on your clothing and pull on the stitch holding them in place and that hurts, the site that the drains come out tends to be tender and there is always a scar where they come out (even if they come out the ends of the transverse scar). In addition, in a study we are publishing, we noted that the rate of fluid collections (seroma), the very thing the drains are supposed to prevent, was dramatically decreased using the no drain tummy tuck procedure. So, for these reasons I no longer use drains and prefer the no drain tummy tuck. The results are similar, but my patients and nurses have noted that the recovery is easier without the annoying drains. I hope this helps and best wishes

Jed H. Horowitz, MD, FACS · Answer

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 abdominal #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.Information that you read online may not apply to your personal situation. All surgical procedures carry some degree of #risk. Always discuss your issues and concerns with the Plastic Surgeon during and following your consultation. The suitability of your procedures and any specific risks may be determined during you #consultation. Also, another element to a satisfying result of your procedures are realistic #expectations. The best method and #technique for your #procedures will be discussed in greater length during your one-on-one consultation with a board-certified plastic surgeon.

Sheila S. Nazarian, MD · Answer

Whether or not you use drains will not affect your recovery. The right decision for you is really up to you and your surgeon. My best,Dr. Sheila Nazarian@drsheilanazarian on Instagram

Ram Kalus, MD, FACS · Answer

Many of my colleagues have provided excellent answers. Any time you create a surgical space by virtue of lifting the abdominal skin, tightening the muscles, and excising the excess skin and re-suturing for a prettier and tighter abdomen, the potential exists for the body to produce fluid (serum) and in the absence of drains, you are likely to experience a bit more short term swelling, and the risk of a post-operative seroma that will require drainage in the office with a needle. The "quilting" technique theoretically eliminates the need for drains in some surgeon's hands. In my 25 years of experience, I have almost always used drains, even if short term for a few days, and I have rarely regretted doing so. No patients ever relish the idea of drains, but they definitely reduce the likelihood of short term swelling, and the likelihood of post-operative seroma, and they should not be left any longer than absolutely necessary. I myself do not charge more for the quilting technique, but this is a personal decision for each plastic surgeon to determine their own surgical fees for any given procedure. Make sure you are confident that your plastic surgeon seems to be the right fit for you, and that her or she are board certified and experienced in body contouring surgery.  Best of luck to you.

Jerome Edelstein, MD · Answer

Hello, Thank you for your question. Progressive tension suture  has helped resolve one of the lingering problems associated with recovery: the use of surgical drains. After the traditional form of abdominoplasty is complete, patients are typically fitted with small, thin tubes that pass through the skin. For about one to two weeks following surgery, these tubes are used to drain any of the excess fluid that accumulates in the potential space between the skin / fat and the muscle left behind by the surgery and ensures a safe, speedy recovery. Without drains, the fluid that naturally collects in the wound can stop the underlying fat and muscle tissues from coming together and properly healing.The use of drains can lead to certain problems, though. Patients often report irritation and discomfort with the drain itself, annoyance regarding limitations on movement, and the need to empty the drains two to three times per day. Drains also carry the risk of creating infections, making unnecessary scars, and can also technically malfunction.While using PTS to create a drainless tummy tuck may take the surgeon slightly longer to perform, the benefits of the approach are well worth it. Not having drains in place makes the recovery process more comfortable, cost effective, and less painful. There is also a greatly lessened risk of infection, additional scarring, and healing complications. When PTS is used, the tummy tuck heals more quickly and recovery isn’t as difficult for the patient. I'd recommend booking a
consultation with a Board Certified Plastic Surgeon to determine what your
options would be.
Take care.

Vincent N. Zubowicz, MD · Answer

The use of drains with any procedure is at the discretion of the surgeon. I personally don't use drains with the type of abdominal procedure that I do. However, it's more important to choose the surgeon who will give you the best result not whether or not drains are used.

Steven J. Rottman, MD, FACS · Answer

Thank you for your question. I always place a drain with tummy tuck surgery. The drain typically comes out within 3 - 5 days and does not cause the patient significant discomfort. I believe it is better to have the drain close down the space between the skin and abdominal wall than have the potential for a seroma to develop which would require multiple aspirations. Hope this helps and good luck with your surgery.

Robert M. Tornambe, MD · Answer

Surgeons differ over aspects of technique of Tummytuck. Some advocate "drain less surgery" using quilting technique. There are pros and cons to this technique, cons including increased OR time and skin puckering. It should not cost more. Be sure to consult with a board certified plastic surgeon to help guide you. Good luck!

Nelson Castillo, MD · Answer

Thank you for your excellent question.  In my practice I still use drains during tummy tucks, especially for larger skin removal patients or when liposuction is also performed.  Though I perform quilting/progressive tension suture techniques I still place at a minimum one drain which is typically removed within a week and does not cause the patient much issue.  There is a balance between your body "sealing" itself after surgery and producing fluid into surgically created spaces. I think the risk/reward ratio still favors a drain over repeated aspirations in the office if a seroma develops.  Hope this helps.

Reps B. Sundin, MD · Answer

I almost always recommend a post-surgical drain for 1-2 weeks after
surgery, primarily to avoid a seroma, or collection of fluid under the skin
which may require additional surgery.There are new drain-less techniques in development, but they have not
yet proven successful in the long run.Utilizing additional sutures underneath the abdominal flap can lead to
distorted results, and while some surgeons are recommending the use of a new
adhesive, there have been no long-term research on the effectiveness of this
approach.

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