Why do some doctors use drains after a tummy tuck?

Thank you for your question. During a tummy tuck surgery, there is space between the abdominal wall and the overlying fat and skin (the abdominal flap). The body will do what it usually does during the healing process, produce fluid, if nothing is done to close this space. Because there is nothing to confine the fluid from accumulating, a seroma can develop in this space. In other words, the tissue produces fluid more quickly than it can reabsorb.Negative suction drains are placed in spaces like this to get rid of the fluid and create suction between the tissue planes. There is a way, however, to eliminate this space without using uncomfortable drainage tubes. Dr. Patel utilizes progressive tension sutures inside the tissues to close off the space and relieve tension on the last surgical closure. This results into less pain, less discomfort and less tension. Also, there will be better scarring with potentially minimizes infection risk.We have successfully used progressive tension sutures during abdominoplasty instead of surgical drains, with a lower seroma rate than is generally thought to occur with tummy tucks and drains. With this method, the seroma rate is close to zero and you cannot beat that approach. Bets of luck!Dhaval M. Patel Double Board Certified Plastic Surgeon Hoffman Estates Barrington Oakbrook Chicago

Dear ChristATL, this is a great question. Ultimately, the decision to use drains depends on your surgeon’s preference as well as the patient’s needs. Drains are great for treating large areas (such as the abdomen) and will typically be removed within a week after surgery, although they may be in for longer if there is extensive fat removal during your tummy tuck. Drains are used to prevent fluid collection at the incision site (known as “seromas”). If you develop a seroma, which is characterized by hardened tissue and accumulated fluid, your surgeon will need to remedy this by needle aspiration. For severe cases, surgical correction may be employed to remove the seroma. Drains are intended to prevent painful fluid accumulation at the incision sites and minimize complications.Currently, many surgeons are attempting to make the healing process less complicated (and sometimes less painful) by using quilt-like sutures. The surgeon eliminates any so-called “dead space” between the skin and underlying tissue where fluid would accumulate by suturing the two together. By closing this dead space, it becomes less likely that fluid will accumulate at the incision site (however, there is always some risk of fluid accumulation regardless of the method used). Ultimately, the choice of using drains or a drainless method depends on your physician’s preference and each method’s suitability for the individual patient.

Using drains after an abdominoplasty is a common practice. Several years ago the "progressive tension suture" method (the "quilt like" sutures) was presented as a way to help prevent what we call seromas. (This is a collection of fluid that builds up under the skin and fat layer. Sometimes an additional surgery was needed to get rid of them.) The surgeons that described this found that drains were no longer necessary when these sutures were used. Other benefits have also been noted. There are other abdominoplasty techniques that do not require drains. The specifics of these techniques are surgeon dependent. If you like the results that your surgeon has shown you and you are comfortable with your surgeon, drain or no drain should not make any difference on your outcome. Swelling will happen and resolve similarly with each technique. Best wished for your surgery!