About No Drain Tummy Tucks
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
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.
Drains after a tummy tuck
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.
Drains and Sutures for Tummy Tucks
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!
Why I use drains with tummy tucks AND Progressive Tension Sutures
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.
Use of drains after tummy tuck has been a present for a long time. Progressive tension sutures greatly diminish and/or completely eliminate the need for drains after tummy tuck in many cases. Although not a new concept (ie., drainless surgery for tummy tucks), it has seen a resurgence in popularity in the past several years. Use of drains or not is patient and case-dependent based most often on the surgeon's judgement with regard to the individual patient's needs. Rest assured that drains after tummy tuck are utilized for the specific reason of preventing complications that might require additional surgery later. Hope this helps.
Drains or Drainless Tummy Tuck
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.
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
Robert Singer, MD
La 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.