13 days post op drainless tummy tuck and for the last few days I am draining through my incision. (Photo)

There's a movement to get away from placing drains after a tummy tuck which is very appealing to patients and surgeons. The surgeon has to do more than just skip placing the drain. He/she needs to place quilting sutures underneath to minimize the open space between the muscle fascia and the overlying fat and skin. You have a seroma, which looks clear (non-infected), but need to see your surgeon to aspirate it. It looks like it's found its way out through your incision. You also seem to have a little cellulitis (skin infection) in the mid supra pubic skin and I can't tell if your belly button has a scab in it or it is necrotic, non-viable. In any case, try to see your surgeon, sooner than later. Good luck.

You should contact your surgeon and ask them to take a look at your wound. If there was excessive fluid collection it is better that the fluid drains out than that it stays in. The wound will heal once the excessive drainage has slowed down. Your surgeon may put you on an antibiotic for a while to prevent infection. I expect that this will resolve without too much trouble. Good luck

Although uncommon some surgeons still get a small percentage of their drainless tummy tuck developing fluid collections. The picture shown indicates an effusion of fluid, and the redness around the lower incision indicates a likely skin infection, which might be associated with fat necrosis.  A situation like this would likely be treated with placement of a seroma catheter which is a percutaneous insertion of a thin catheter, that is sutured to the skin and attached to a collection bulb. With continuous suction and some antibiotics one would expect this situation to resolve.In my practice, the occurrence of clinically significant seromas requiring aspiration has been two in the past five years.  The technique is good, but I like to make sure all the space is thoroughly closed, so unlike Drs. Pollock I use enough suturing to almost completely close the space. 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.

Over the years, surgeons have improved procedures and found ways to eliminate the need for #drains commonly used in a #tummy #tuck or #abdominoplasty, and a variety of other operations. 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. 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. The use of tissue #glue is to adhere the abdominal #skin to the #muscle. It is a new option and alternative to sutures in a tummy tuck. 
It's best in this situation to be seen and evaluated by your doctor or their staff to confirm as to whether you have a seroma or an infection. They will also be able to drain the fluid and possible add sutures or tissue glue to reduce the fluid leakage. 

This is exactly why drains are critical after tummy tuck.  You will generate the fluid whether you put drains in or not.  If there are no drains, it will accumulate and work its way out from the wound.

Based on your description, it sounds like you developed a seroma following a drainless tummy tuck.  One or a couple of the progressive tension sutures may have failed or were spaced too far apart.  This is a known possible complication that can be managed effectively without any long-term effects in most cases.  An ultrasound followed by fluid extraction (aspiration) is the appropriate management.  Some patients will require repeated fluid aspirations that can be performed in the office.  Leakage of fluid from the incision is a nuisance but not a concern; in fact, it is actually helpful to resolve the problem because the fluid your body is producing is coming out rather than building up.  Having some discomfort in the area of the aspiration is not uncommon and will typically resolve quickly.  I would recommend following-up with your plastic surgeon closely with the potential need for repeat aspirations until the fluid no longer collects.  Best of luck!
Ziyad Hammoudeh, MD@drhammoudehMayo Clinic-trained, Double Board-Certified Plastic SurgeonDiplomate, American Board of Plastic SurgeryDiplomate, American Board of Surgery

Thank you for your question
From what i can see on your pictures, you seem to have a small opening in your incision and the seroma is linking from this spot. Also some redness around your incision.
I recommend you book an appointment with your surgeon soon to get a complete assessment of the situation. You may need some antibiotic. Make sure you are wearing your compression garnement and that they are thigh on your stomach to reduce the shearing (which can increase seroma)
Best Wishes
Dr Genevieve FCaron, Board Certified Plastic Surgeon
Montreal, Canada

I am sorry to
hear that you are having difficulties. Fluid accumulation after an
abdominoplasty that was designed to eliminate drains by using quilting stitches
can occur. This becomes annoying, when you stand up and fluid drains through
the skin.You may want to
discuss with your surgeon if you need a drain placed and wound culture of the
fluid. In my experience, this may resolve the problem. Good luck!

It sounds like your seroma has re-accumulated. You need to contact your doctor and get it either re-drained as before or have a drain placed.  Good luck.

A tummy tuck causes the body to secrete substantial amounts of fluid in all patients in response to the surgical injury to the tissues. That's why a drain is placed - to drain it out. Drainless TTs are tempting, but IMO not a great idea, because even with quilting stitches, you can have undrained pockets of fluid and problems. You need to see your surgeon relatively soon for further evaluation and probably some drainage.