Which would you recommend; drain or drainless Tummy tuck?

iam currentlycurrently doing my research on board certified plastic surgeons to do my tummy tuck and breast augmentation but I came across something called a drainless tummy tuck and it sounds really interesting and I have read lots of great reviews from women about it like less swelling ,quicker recovery , no stich removal ...ECT ... but I was wondering can you give me some of your thoughts about it ? PRO'S and CON'S ? And would you recommend it ? Thank you in advance ❤

Doctor Answers 18

Bye Bye Tentacles!

Hi Shaniavega94, 

Many plastic surgeons, myself included, have moved away from using the tentacle like drains for most tummy tuck patients. I have just seen in my own experience, the useful function is outweighed by the downsides to drains. Historically we used drains to aspirate fluids that accumulate under the skin flap of an abdominoplasty (tummy tuck). There is a large area of skin that is lifted off the abdominal muscle wall and after tightening the muscle the skin is pulled down, the excess removed and sutured down over usually, two, drains. The skin underneath with its attached fat, oozes fluid which can collect just above the pubis as a large seroma. To avoid this the drains are employed to suck this fluid out. It just made sense.

Unfortunately there are downsides to drains which can cause other problems. For patients, most notably drains are very inconvenient as they come out of the body and go to a collection bulb. These are uncomfortable at the least, but can also cause pain if they get snagged on clothing or objects. They are always sucking against the inside muscle and soft tissues and can also pain this way. They hamper mobility and make it impossible to take a shower for up to 2 weeks. Thus the patient has to do sponge bathing, find clothes that will fit to cover the 2 bulbs (reservoirs holding the old bloody fluid) and probably prevent the patient from standing upright as quickly as those with out the drains (my observations). 

From a medical stand point, someone must maintain the cleanliness of the drains where they exit the skin and empty and record the collection amounts 3 times a day. (The longer the drain is in place the higher the risk of an infection which can occur by tracking its way up the drain tube.) There is a large margin of error there. Finally, there is not even a guarantee that they will prevent a seroma! Some times after they are removed, the patient will still need to be aspirated (needle/syringe suction).  

So, what are the benefits of no drain? MANY! Less overall pain, quicker straightening up and mobility, patients may take a shower the next day or so after surgery instead of 2 weeks, less risk of infection and no need to keep a drain log, no embarrassing moments having family members emptying and maintaining the drains for you (this is actually a significant issue for patients). For your surgeon, not using drains means it typically takes 20 minutes longer in the OR, but that is easily recouped when you consider there is no maintenance by either medical staff or patient and family members in dealing with these drains! You may need to have some aspiration if there is a seroma accumulation, but not anymore frequently than if you had drains. So which would you rather have? Be tentacle free!! 


Orange County Plastic Surgeon
4.9 out of 5 stars 35 reviews

No Drain Tummy Tuck is the way to go!

There is a lower rate of seromas (blister fluid collections, the very thing drains are supposed to prevent) with the use of the No Drain Tummy Tuck. Numerous studies have shown this since the procedure was described 16 years ago using progressive tension sutures. I recently published our center's experience of over 450 tummy tucks during the period where we switched to the No-Drain approach, and it showed the the seroma rate was decreased from 9% when using drains to 2% when using the progressive tension sutures and no drains.

The average increase in time spent in the OR placing the progressive tension sutures in only 23 min when you look at all of the studies on the subject. As for a slightly higher cost... you get what you pay for.

There is a prospective study which was presented at our national meeting a couple months ago that showed that patients got to normal activity quicker and had less pain. 

It is absolutely safe and my prediction is that drains in tummy tucks will eventually be a thing of the past as more surgeons get trained in the technique.

I hope this helps and best wishes.

Recommendation for Drainless Tummy Tuck

I have always employed drainless tummy tuck, which is the progressive tension technique- because that is how I was trained in plastic surgery residency, but also because my experience has been less fluid collections (seromas/hematomas).  If you ask patients what they most dislike about their tummy tuck procedure, most would say having the drains.  The con, is that it does add some time to the operation itself, but this is minimal time in someone who has routinely performs the operation this way.  Obviously I recommend it.  Best of luck.

Michael Marion, MD
Sandy Plastic Surgeon
5.0 out of 5 stars 14 reviews

About No Drain Tummy Tucks

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. Best of luck!

Dhaval M. Patel

Double board certified

Plastic Surgeon

Hoffman Estates

Barrington

Oakbrook

Chicago

Dhaval M. Patel, MD
Hoffman Estates Plastic Surgeon
4.8 out of 5 stars 79 reviews

You don't need drains ! Check out our research

Progressive tension sutures without drains have a lower complication rate than using drains alone.   I drained for over 20 years and now haven't for over 4.    Our seroma rate is less than 1/4 of what it was  and I have only seen small easily treated one on almost 4 years!    Patients love not having to deal with the drains or the scars.   Everyone loves the lower complication rates. 

Grant Stevens, MD
Los Angeles Plastic Surgeon
4.8 out of 5 stars 137 reviews

Drain Vs No Drain TT

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.

No drain tummy tuck

a no-drain tummy tuck is as safe as any other tummy tuck procedure. This is typically done using the progressive tension suture technique, which I published a modification. The fact that no drains are used also reduces the chance of postop infection.
I have experienced far fewer postop fluid collections since I began using the no drain technique than when I used drains many years ago.
Because there are no drains, getting up and walking is easier, and showering can be started the day after surgery.
As far as results, the scar has definitely improved since I began using the progressive tension suture technique and I have also noticed an improvement in the contour of the anterior waist/lateral abdomen.
The short term downside to the progressive tension suture technique is that for the first 4-6 weeks there are some dimples and creases over the abdominal skin, however these will eventually go away.

This information is for educational purposes only and is not a substitute for a consultation with a plastic surgeon certified by the American Board of Plastic Surgery.

Thumbs Up for Drainless Tummy Tuck

I used drains for all of my tummy tucks up until a few years
ago.  I found that over a period of more than
10 years, the majority of calls I received from patients after surgery
were related to problems with their drains.  Some of the problems included blocked or clotted drains, body fluid drainage
from around the drain tubes, drains being accidentally pulled out, loss of
suction and function of drains resulting in buildup of fluid in the wound,
infection, pain at the drain exit site, caretaker and patient anxiety over
drain care, delayed healing and the need for reinsertion of drains because of
seroma formation following drain removal.   Additionally, scar indentation following drain
removal has occurred, requiring scar revision.

I started performing a drainless technique using a
continuous stitch to close the dead space that occurs between the fat and
underlying muscle fascia and found that all of the problems patients were
having suddenly were no longer occurring.

My patients have been very happy with their results and
often tell me that their recovery from surgery was so much smoother than
friends who had a tummy tucks with drains.
In fact, recent study discussed at this year's American Society for Aesthetic Plastic Surgery annual meeting showed a much  lower complication rate with the Drainless tummy tuck compared to when drains were used.

I would encourage you to find a well-qualified surgeon in
your area that has had lots of experience and success with the drainless tummy
tucks and to go for it.

I hope this answer helps.  Good luck!

I don't use drains

But believe me, it is the same tummy tuck of traditional style that we all the PPSS do; it is a question of meticulous hemostasis and skills excellency. In my beginnings I was addicted to use drains in the smallest procedure, but now I have learnt with the years that the lines are not so clear sometimes.

Alejandro Nogueira, MD
Spain Plastic Surgeon
5.0 out of 5 stars 34 reviews

It is possible to have a tummy tuck without drains, but....

It is possible to have a tummy tuck without drains, but it is a trade off. As a result of the progressive tension sutures, the skin is not pulled as tight in my experience (patients are able to stand upright because not as much skin is removed). Also despite the fact that they say that no drains are used does NOT mean that you won't get a seroma (fluid collection) that may require drainage in the future. I would say that the majority of plastic surgeons use drains routinely.

I'm glad you are doing your homework and educating yourself. In reality what you really want is a plastic surgeon that gets great results and who has happy patients as a result of their skill and expertise. Don't choose a surgeon just because they tell you what you want to hear. If it is a good technique and you like the results and they have happy patients then you can be reassured that you may expect a similar outcome.

I wish you luck!

Richard H. Fryer, MD
Salt Lake City Plastic Surgeon
4.9 out of 5 stars 250 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.