Tummy tuck - why do some surgeons not use drains?

Surgeons who use the drainlesstechnique tend to overemphasize this as a selling point.  It is true that drains are annoying for about 5-7 days.  However, in the end, you should only be choosing your surgeon based on the results that they can deliver.  Based upon their artistry and their results.  Looked through a bunch of pictures.  He will see plenty of "drainless" tummy tuck results which are terrible, as you will with those who have used drains.  My opinion is to pick your surgeon on their ability, not on a temporary inconvenience. Best of luck!
Dr. SubbioBoard-Certified Plastic SurgeonNewtown Square/Philadelphia, PA

There are a variety of procedures that are performed as "tummy tucks." These include some specific techniques that have been developed to reduce the need for drains. Different surgeons will have varying outcomes from different procedures and most surgeons evolve to find the techniques that work best for them. Ultimately, the decision to use drains comes down to personal preference. This is a question that can be asked of your surgeon during a consultation. 

Hello,
Although you have heard a variety of answers from my colleagues, some of which is frank misinformation, the science tells us (almost a dozen published papers in the last few years) that drains contribute to not only the number one complication of tummy tucks (seromas), but also increase the risk of infection. The reasons most surgeons have not stopped using these antiquated devices are many. First you need to know that surgeons can't simply just stop using drains. There needs to be something else done, either suture closure of the large subcutaneous space (my preference), or the use of fibrin 'glues' made from the patient's blood.  The suture technique, AKA progressive tension sutures or PTS, is difficult to do, has a fairly steep learning curve, and is time consuming (time = money). Fibrin glue products are simply expensive. The benefits of PTS extend beyond obliterating the space, however.  They also progressively set the tension of the skin from the very top (near the breasts), where the skin tends to be tightened the least in a standard tummy tuck, all the way to the pubis, where the skin tends to be over tightened (leading to poor healing and scarring).  So, you get a tighter upper abdomen, more skin translocation, and a better scar. Go visit a few ABPS certified/ASAPS member surgeons who use PTS as a mainstay for their tummy tucks!

Some surgeons use drains and some do not.  Those that choose not to use drains will close the space between the skin/fat and the abdominal fascia/muscles by placing quilting sutures to close the space down so there is no fluid accumulation.  It ultimately depends on what the particular surgeon can get the best results with.  That should really be the focus of a prospective patient.  I would not worry how your body gets there but what is the final result.I tend to like using drains because it is predictable and I feel that with quilting sutures, there is always the risk that where a suture is placed can dimple and show postoperatively.Hope that helps.

The purpose of drains is to collect fluid that your body would otherwise have to absorb. When the tissue flap is raised, the surgical areas will leak some fluid as they heal. This is a normal part of the healing process, and the amount of fluid made decreases day to day, allowing most tummy tuck drains to be removed around 5 days after surgery in my experience. My preference is to use drains, and allow drainage of this fluid in the early postop period when your body generates more fluid. Once the drainage slows down, the thought is your body can handle the smaller amount and absorb it, and the drains are removed. There are different techniques to tummy tucks, and the surgeons who do not use drains tend to use quilting sutures, or progressive tension sutures, in an effort to minimize the chance of fluid collecting while the abdomen heals. These techniques actively close down the space, but can also show visible dimpling or contour irregularity while healing. Without drains, your body is expected to absorb whatever fluid is generated. Some surgeons also like the marketing advantage of saying they don't need to use drains. However, the final results are what really matter, not the minor and temporary inconvenience of having a drain. The price of the drains is not a determining factor in whether or not they are used. 

The use of drains with a tummy tuck procedure varies among surgeons.  Most plastic surgeons use the drains,  however some use surgical techniques that negate the need for the drains.  Nice results can be achieved with either technique. I have tried the tissue glue, quilting sutures, and drains.   I prefer to use fluted drains which are painless to remove. Any drain can be a little bit cumbersome, however they are well tolerated and typically removed after the first week.  Discuss this with your surgeon. Best wishes to you!

There is not a big difference in final outcome with or without drains barring complications.    I do think there is quite a difference in patient experience, however.Traditionally a drainless tummy tuck involves closing the space between the skin and body with quilting or progressive tension sutures.   Closing this space reduces the amount of fluid and if properly executed can minimize seroma risk.    There is a new method to close this space without progressive tension sutures called TissuGlu.   I have been using this FDA approved product a lot in the past year and have been very happy with the results.   I find that the amount of adherence, resistance to shear, and degree of fluid created is much less with TissuGlu than with either drains or progressive tension sutures.  I have witnessed the patient experience is much better.   It's not only having no drains that they appreciate, the pain and recovery have been markedly improved.   My theory is that the raw nerve endings are less irritated with firm adhesion.   Less shear and motion = less pain and less swelling.   I have provided a brief video of the procedure. 

It's a great question. Research has shown that drains are not needed to prevent seromas after a tummy tuck procedure which has been performed using progressive tension sutures. Regardless of these studies, some surgeons perform their tummy tucks using different techniques that work well for them. In my office, I use progressive tension sutures and drains. However, my drains only stay in place for about 3-5 days. Without progressive tension sutures it's common for drains to stay for 10-14 days.

Dear sugarlumpspony,In my opinion, surgeon's preference and experience plays an important role in using drains. Nowadays many surgeons try to avoid drains by placing tension sutures to reduce the space between the muscles and fat tissue. However, drains are not expensive and can be an excellent choice to reduce swelling and possible seroma. Daniel Barrett, MD, MHA, MS 
Certified, American Board of Plastic Surgery  
Member, Am. Society of Plastic Surgery

This is a good question.  Tummy tucks require undermining and the creation of a flap.  This can result in a potential space that can fill with blood or fluid.  To prevent this, some surgeons use drains, and others will use internal pleating sutures.  Your surgeon can discuss with you the benefits of each.  The great majority of patients undergoing tummy tucks do have drains for a short period of time.