Pros and Cons between drains and Drain-less Tummy Tucks
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.
Are drainless tummy tucks safe?
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.
Drained vs Drainless Tummy Tuck
The issue of whether to use a drain in a tummy tuck is not one of safety but whether you will develop a fluid collection (seroma) later. While there is good appeal to not having a drain after a tummy tuck, it cost a little more to do because of the extra time and sutures to quilt the dead space closed. But even so doing does not guarantee that a seroma will not develop later. Using a drain adds some inconvenience to the patient but poses no risks in doing so and is the most assured way to lessen the risk of a fluid collection later. Each patient needs to be considered individually and the size of the tummy tuck plays a major role in the merits of using a drain.
Drainless Tummy Tuck
The drainless tummy tuck is becoming more and more commonly performed and involves the use of progressive tension sutures that close the open space that is created during the procedure. There has been some compelling evidence that it works very well. There are also practitioners that use both the progressive tension sutures and drains. More clinical research is needed to determine if there is a superior method. Both seem to be safe. Good Luck,
Tummy tuck with no drains
An abdominoplasty can be safely performed without drains, in the proper settinig. On the other hand drains, while a short term nuisance, have very little risk.
Are drainless tummy tucks safe? What are the pros and cons between drains and drainless?
There is an ongoing debate in Plastic Surgery on this exact issue. For safety ALWAYS use a drain even if it comes out after a few days. Better safe...
New Study Shows Superiority of Drainless Tummy Tuck
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!
Tummy Tuck : Drains or no drains
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.
Drains and Tummy Tucks
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
To drain or not to drain an abdominoplasty
It is usually up to the plastic surgeon to decide whether or not to use a drain. Both methods are safe.