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.

In some cases a tummy tuck or #abdominoplasty can be completed without #drains. The #drainage tubes are used by trained Plastic Surgeons for many different operations.  The purpose is to release extra fluid that may otherwise accumulate under the skin, fat or muscle following an operation.  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.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. Your board-certified plastic surgeon will recommend the type best suited for you. The most important decision to be made before performing any surgical procedure is determining whether you are an ideal #candidate.

Early in my career I use drains on all abdominoplasties. This was done to decrease the risk of postoperative seromas. I now use a quilting technique without drains and have almost eliminated seroma formation my patients.

It depends on how your procedure is performed.  To be "safe" it may be a good idea to have drains applied but it does not guarantee that you will not develop fluid below your skin surface.  Best to discuss this with your doctor. 

I have heard of some plastic surgeons not using drains.  They have to do a bit more surgery in order to place enough stitches deep to try and close off the large space created in order to remove skin and tighten muscles.  This may add to your surgical costs.  Adding one or two drains lowers the risk of fluid collections while you are healing.  They may seem weird to have but they are easy to take care of at home.  I have performed over 1000  tummy tucks without any major drain problems and a very low rate of fluid formation.

I typically perform progressive tension sutures in all of my tummy tucks so that the space between the skin and underlying abdominal muscles is closed off with sutures to prevent fluid from accumulating and forming a seroma, which avoids the need for drains.  The lack of tubes hanging from your body helps with quicker return to activity in the early recovery period; this also means no need to empty blood-tinged fluid every day from the drains, which is very favorable for patients.  Placement of progressive tensions sutures does require some additional time and surgical expertise, but is well worth it.  Avoiding the supply cost of drains essentially neutralizes the additional operative time cost.
However, some surgeons have yet to adopt this technique.  The reason for that is likely related to the fact that they were not trained to perform progressive tension sutures in their residency, they do not believe it works, or they are not willing to spend the additional time required to place progressive tension sutures.  The additional time required is minimal in experienced hands.
A seroma can develop after progressive tension sutures, but the rate is very low and similar to the rate of seroma with drains.  Even with drains, a seroma could develop in an area where the drains are not positioned under the skin.  I have yet to develop a seroma following a drainless tummy tuck with progressive tension sutures since starting my practice.  Our office has published on the effectiveness of progressive tension sutures compared to drains in plastic surgery journals with excellent results and high patient satisfaction.
Ziyad Hammoudeh, MD

I have performed drainless tummy tucks for many years and have found it to be a safe and reliable procedure when performed in appropriate surgical candidates.  I have not had any problems with seromas.  The length of surgery is increased somewhat, but I have been able to shorten my operative times by using a suturing technique which is somewhat different that is typically described by other surgeons.  I use a continuous stitch which is woven back and forth to secure the overlying fat to the underlying muscle fascia (fibrous covering of a muscle).  An average of 10 to 15 minutes is added to the length procedure, however, the closely woven continuous stitch that I use allows me to completely close the “dead space”, which is the reason I have not had problems with seromas.In my experience, the extra time is very well justified, because all of the potential problems associated with drains have been eliminated.  Because the tissues are securely attached to one another, healing between the fat and underlying tissues begins immediately.  This allows patients to be more active during the early postoperative period, which in turn helps prevent potentially fatal clots from forming in the legs I believe that conflicting views between surgeons are often the result of varying levels of experience with a particular procedure.  Therefore, I would advise you to find a board certified plastic surgeon that has significant experience and success with drainless tummy tucks. I hope that you find this answer helpful.  Good luck!

To drain, or not to drain; that is the burning question. The decision is dictated by the extent of the procedure. Non formation of seromas, can neither be assured by using drains, nor by the drainless technique. Therefore, while I might not use drains for mini tucks, I would prefer to use them in a lipoabdominoplasty just for "safety" with no extra downtime added to the patients recovery.