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

Our meta-analysis (link below) revealed that a "drainless tummy tuck (abdominoplasty) with progressive tension sutures" was more effective than the traditional "tummy tuck with drains" in reducing seroma (fluid buildup) and reoperation rates, with no significant difference in hematomas or infections.
Despite these findings, many plastic surgeons continue to use drains during tummy tucks (typically since they were trained to use drains and continue this standard practice). Drains are typically used to prevent fluid accumulation under the skin, a common issue after the procedure. Fluid buildup, known as a seroma, can slow the healing process and lead to complications. Drains help remove this fluid, ensuring proper healing and minimizing complications. However, drains can be uncomfortable, require extra care, and increase the risk of infection at the insertion points. They can also leave scars, even after removal.
The introduction of the "drainless" tummy tuck, typically performed with progressive tension sutures, offers a promising alternative. These sutures close any dead space in the skin flap, significantly reducing fluid buildup and seromas. This technique eliminates the need for drains, which can lead to faster recovery times and less post-operative discomfort. While effective, this method has some challenges, such as a slightly longer surgical time and the need for a skilled and experienced surgeon. Some surgeons may still opt for drains, particularly in patients with certain body types or those undergoing significant liposuction, due to concerns about fluid accumulation. However, as evidence supporting the benefits of drainless tummy tucks continues to grow, this approach is gaining popularity for its improved patient comfort and smoother recovery process.
Though not all patients are ideal candidates for the drainless technique, it has proven to be a highly effective option. To ensure the best outcome, it's essential to consult with a plastic surgeon experienced in this technique. Incorrect placement of the sutures can lead to contour deformities or dimpling, and may require reoperation. Be sure to speak with a qualified 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

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!

I have been using progressive tension sutures for nearly 20 years, so it is not a newer method. I found early on that the amount of fluid in the drains is diminished but it is not zero. There are other benefits to the PTS method, and the drains can come out earlier than without. 

Thank you for sharing your excellent question.  The decision to use drains, quilting stitches, or both is a decision best made by your surgeon assessing the relative risk of you forming a discrete fluid collection.  In my practice I favor drain placement in patient's having more extensive tummy tucks and having liposuction performed at the same time.  Hope this helps.

Hello ChrisATL, hope all is well and that you are having a great start to your weekend. Every plastic surgeon has a list of post-operative instructions that they ask patients to follow. Communicating your concerns with your surgeon will be helpful to you and him/her, your surgeon is the best person to address your questions and concerns since they know what procedure was done. The decision to use drains, quilting stitches, or a combination of both is a decision best made by your surgeon assessing the relative risk of you forming a discrete fluid collection.

Quilting sutures are not new for tummy tucks; they've just become more well-known recently because some surgeons are using the procedure for marketing purposes.  Drains are tried and true and temporary.  

Some excellent plastic surgeons use drains, some use
internal quilting sutures, and some use both. Whether a surgeon uses drains or
not should be one of the least important factors in choosing the surgeon. The
choice of drains or no drains should depend on the extent of the procedure and
the surgeon’s opinion based on his or her experience. Good results have been
obtained both with and without drains. The length of the recovery and the
extent of swelling are not diminished in procedures where no drains are used.What is far more
important, is the choice of the surgeon. I would suggest you find a plastic
surgeon certified by the American Board of Plastic Surgery and ideally a member
of the American Society for Aesthetic Plastic Surgery (ASAPS) that you trust
and are comfortable with. You should discuss your concerns with that surgeon in
person. While a second or third opinion may be worthwhile, continuing to pursue
consultations until you get the answers that you think that you want to hear
may not necessarily be in your best interest. If you are ambivalent, don’t do
the procedure.Robert Singer, MD
FACSLa Jolla, California

Using drains after tummy tuck or using progressive tension sutures is widely excepted. It mainly depends on your surgeons comfort level and exactly what the surgeon is doing that will dictate what technique will be used to minimize fluid development.  

Thank you for the question. It is extremely common to receive different opinions from different plastic surgeons about the best way to treat a specific “problem”. Each plastic surgeon may have his/her opinion that is based on their specific/unique education, experience, and personal preferences. Their opinions may also be shaped by unfavorable results they have encountered in their practices.Although these different opinions can be confusing and a source of anxiety for patients, it is good for patients to understand the different options available. Ultimately, it will be up to each patient to do their due diligence and select their plastic surgeon carefully. Part of this selection process will involve the patients becoming comfortable with the plastic surgeon's experience level and abilities to achieve their goals as safely and complication free as possible. In my practice, I currently use drains for all tummy tuck patients; I also use progressive tension sutures for most patients.I hope this, and the attached link (dedicated to tummy tuck surgery concerns), helps.