Which would you recommend; drain or drainless Tummy tuck?

In my opinion, there are no cons.  Other than adding some time, and therefore some expense to the procedure, there is no downside or risk to using a drainless technique.  The flap has to be sutured down evenly without dimpling the skin, and the space needs to be closed thoroughly. When this is done correctly, the patient is free from all  the cons associated with drains, namely scarring from drain holes, discomfort and limited mobility from drains, reoccurrence of fluid collection when drains are removed, and a relatively high percentage, 5-24% in the literature of having to aspirate fluid collections multiple times, and the risk of a persistent fluid collection or bursa that will require another operation to correct. Drainless tummy  tucks are an integral part of my procedure.   A meta-analysis in the Aesthetic Surgery Journal, 

Aesthet Surg J. 2017 Mar 1;37(3):316-323. doi: 10.1093/asj/sjw192.

Seretis K, Goulis, D, Demiri EC, Lykoudis, EG

Prevention of Seroma Formation Following Abdominoplasty: A Systematic Review and Meta-Analysis

reviewed all the literature on this topic, and found that "preventive measures" decreased the incidence of seroma four-fold. One of the studies included in the "preventive group" that used only progressive tension sutures, from 2006, showed fluid accumulation between the sutures, detected only on ultrasound. This fluid was not clinically detectable by palpation or inspection and resulted in no need for seroma aspiration or any complication. The total amount of fluid associated with clinical complications including drainage in the other groups was greater than 80 cc, and the total amount of non-clinically detectable fluid in the progressive-tension group was always 80 cc or less. The use of drains plus progressive tension sutures did not change the amount of fluid, so there is really no benefit to using drains plus progressive tension sutures.

The study was discussed by Pollock and Pollock, who noted that in their series of 565 patients using progressive tension sutures they never had a clinically significant seroma. When a seroma occurs, it may require multiple visits and aspirations, and if persistent, introduction of antibiotic sclerosing solutions, or reoperation to remove a fluid filled fibrous cavity. The drain opening may leave a scar in the incision or pubic mons which may become pigmented or depressed. Not having to use drains spares the patient and plastic surgeon from the chance of these undesirable events and/or outcomes.

My experience mirrors that of Drs. Pollack.  I have had no clinically significant seromas while using progressive tension sutures in the past five years or so.
Rather than use the 15-20 individually-placed sutures described by Drs. Pollock, I completely close the dead space with continuous PDO and monoderm Quill sutures. These sutures effectively reduce the dead space to almost nothing, so even the small amount of fluid that might collect between the sutures, cannot create any significant seroma. Using running Quill sutures allows relatively rapid dead space closure as no knot-tying is needed. The umbilical location is confirmed with a Lockwood flap marker before the lower abdominal closure is completed.

Drains are a temporary part of the healing after a tummy tuck. They are an excellent way to remove the fluid which will accumulate after elevation the skin and muscle reconstruction. The possibility of developing a seroma with all of its potential problems is far more worrisome than dealing with the temporary discomfort associated with the drains. Look at the surgeon's outcomes. That is how you should be picking the doctor.

Our meta-analysis research (link below) showed that "drainless tummy tuck (abdominoplasty) with progressive tension sutures" were more effective than tummy tuck with drains in reducing seroma (fluid buildup) and reoperation rates, with no difference for hematomas or infections. The potential con is contour deformity and dimpling if the sutures are not placed correctly by an experienced surgeon.
Many plastic surgeons continue to use drains during tummy tucks because it has been the standard practice for many years. Drains are traditionally used to prevent fluid accumulation under the skin, a common occurrence after the procedure. The accumulation of fluid, known as a seroma, can slow healing and lead to complications. Using drains helps remove this fluid, ensuring proper healing and minimizing the risk of complications. However, drains can be uncomfortable, require additional care, and increase the risk of infection at the insertion points. They can also leave scars, even after they are removed.
The advent of the "drainless" tummy tuck, typically achieved through the use of progressive tension sutures, offers an alternative to this approach. These sutures help to close any dead space in the skin flap, significantly reducing the likelihood of fluid buildup and seromas. This technique not only eliminates the need for drains but can also result in faster recovery times and less post-operative discomfort for patients. While it has been shown to be highly effective, it is not without its challenges, such as a slightly longer surgical time and the need for a highly skilled surgeon to perform the procedure. Some surgeons may still prefer to use drains out of familiarity or due to concerns about fluid accumulation, especially in patients with certain body types or those undergoing significant liposuction. However, as more evidence supporting the benefits of drainless tummy tucks accumulates, this method is becoming increasingly popular for its enhanced patient comfort and streamlined recovery process.
While not every patient is a suitable candidate for a drainless approach, the procedure has proven to be a highly effective option. Your plastic surgeon needs experience in this technique, because incorrect placement of the sutures can cause major problems including contour deformities and possible need for re-operation. Be sure to consult with an experienced plastic 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

Your choice of surgeon is far more important than choosing a surgeon based on the drain.  However, the drainless technique is very safe and will improve your experience and help you recover quicker.

In some cases a tummy tuck or #abdominoplasty can be completed without #drains. The #drainage tubes are used by trained Plastic Surgeons for many different operations.  The purpose is to release extra fluid that may otherwise accumulate under the skin, fat or muscle following an operation.  Patients generally find this annoying and uncomfortable and they can impede mobility and therefore slow aspects of #healing. Over the years, surgeons have improved procedures and found ways to eliminate the need for these #drains in a variety of operations; including #tummy #tuck or #abdominoplasty.
I have found that most of my patients do very well with the exception of those have large areas of liposuction or lipo-abdominoplasty.  I may use drains on a case by case basis for these patients.
A newer option now can include the use of tissue #glue to adhere the a#bdominal #skin to the #muscle; eliminating any space that previously required a drain.
If you go to a plastic #surgeon who uses drains, or if your situation requires drains, they usually stay in 3-5 days but may be required to remain in longer. Your board-certified plastic surgeon will recommend the type best suited for you. The most important decision to be made before performing any surgical procedure is determining whether you are an ideal #candidate.

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

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.

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.

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.

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!