Which would you recommend; drain or drainless Tummy tuck?
Doctor Answers 18
Bye Bye Tentacles!
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!!
No Drain Tummy Tuck is the way to go!
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
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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
You don't need drains ! Check out our research
Drain Vs No Drain TT
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
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
It is possible to have a tummy tuck without drains, but....
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!
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.