Are drainless tummy tucks safe? What are the pros and cons between drains and drainless? (Photo)

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.For those patients who choose another surgeon, the question to drain or not to drain is at the surgeon's discretion. There is no consensus at this point though most surgeons still favor drains until the output is generally about 30cc/24 hours. I individualize and if little or no liposuction at the time of a tummy tuck, a minimal or mini-tummy tuck I often do not use drains, whereas for significant liposuction with a tummy tuck and other procedures (#MommyMakeover) I most often use drains but individualize as needed.

Thank you for your question. You will need a surgeon to evaluate in-person to determine if a abdominoplasty is the right operation for you. To answer your question, our meta-analysis research (link below) showed that "drainless tummy tuck (abdominoplasty) 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.
Many plastic surgeons continue to use drains during tummy tucks because it has been the standard practice for many years. Drains are traditionally used to prevent fluid accumulation under the skin, a common occurrence after the procedure. The accumulation of fluid, known as a seroma, can slow healing and lead to complications. Using drains helps remove this fluid, ensuring proper healing and minimizing the risk of complications. However, drains can be uncomfortable, require additional care, and increase the risk of infection at the insertion points. They can also leave scars, even after they are removed.
The advent of the "drainless" tummy tuck, typically achieved through the use of progressive tension sutures, offers an alternative to this approach. These sutures help to close any dead space in the skin flap, significantly reducing the likelihood of fluid buildup and seromas. This technique not only eliminates the need for drains but can also result in faster recovery times and less post-operative discomfort for patients. While it has been shown to be highly effective, it is not without its challenges, such as a slightly longer surgical time and the need for a highly skilled surgeon to perform the procedure. Some surgeons may still prefer to use drains out of familiarity or due to concerns about fluid accumulation, especially in patients with certain body types or those undergoing significant liposuction. However, as more evidence supporting the benefits of drainless tummy tucks accumulates, this method is becoming increasingly popular for its enhanced patient comfort and streamlined recovery process.
While not every patient is a suitable candidate for a drainless approach, the procedure has proven to be a highly effective option. Your plastic surgeon needs experience in this technique, because incorrect placement of the sutures can cause major problems including contour deformities or dimpling 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

Drains are inconvenient, painful, and can leave a tell tale scar.  The drainless technique is more comfortable, easier, and offers a quicker recovery.