Compression garments after abdominoplasty serve three primary purposes: patient comfort, assistance with patient mobility and control of edema. Most tummy tuck patients feel better and have an easier time changing positions (laying to sitting, sitting to standing, etc) and ambulating with the feeling of abdominal support that a compression garment provides. My preference is to start patients out with a three-panel, Velcro-fastened abdominal binder that is easily applied and removed. This allows easy access to surgical dressings and easy inspection of the abdominal skin in the early postoperative period. Patients are placed in a form-fitting but comfortable compression garment at their postop day two appointment after the On-Q catheters (local anesthetic infusion system for postop pain control) are removed. The garment should cover the entire trunk, and ideally should incorporate breast coverage to keep the garment from slipping downward. It should have an open crotch (panties are worn over the garment) so that it does not need to be removed for every trip to the bathroom. Most patients seem to prefer a garment that includes the upper thigh (rather than a 1-piece swimsuit-style coverage at the hips) so that it does not ‘pinch’ in the hip or groin area, although we give patients that choice. Compression also helps to control the subcutaneous edema that is a normal part of abdominoplasty recovery. The process of elevating the abdominoplasty flap (as well as liposuction of the central subcutaneous portion of the flap which is required in most patients) temporarily impairs normal lymphatic drainage. The lymphatic system is responsible for directing fluid that leaks out at the capillary level from the vascular system back to the venous system. Because lymphatic drainage is impaired, it is quite common for subcutaneous edema (swelling) to develop in the flap – which persists until the remaining lymphatic channels recover and new ones develop. Some patients have very little edema postop, and can discontinue the use of their compression garment earlier. Often we have patients wear one, two or three panels of the initial binder over their compression garment to provide added comfort and control of edema. The degree and duration of subcutaneous swelling / edema is definitely reduced by the use of compression garments. We direct patients to wear them as close to around-the-clock as possible for the first two weeks postop, and then all day or all night for the second two week period. Not all compression garments are created equal. As with surgeons and surgery centers, you tend to get what you pay for. In my practice we provide the compression garments for abdominoplasty patients (there is no added fee for compression garments), and we have tried out almost every major company’s garments. We have been happiest with Marena’s compression garments as the fabric is very soft, elastic and comfortable yet durable. They are also the most aesthetically pleasing garments we have used. If modified with scissors the fabric does not ‘run’ or split. If the garments are not pleasant to wear then patients will inevitably discontinue their use earlier than would be ideal. Some practices ask patients to purchase their own garments (I’ve even heard of patients being sent to Wal-Mart for this), which is leaving an important part of the postop care regimen in inexperienced hands. If a practice advises you to purchase your own compression garment, they are probably more interested in controlling costs than your postoperative comfort. In responses to questions about compression garments, some surgeons have proposed a number of potential negative consequences related to the use of compression garments in abdominoplasty patients: patient discomfort, abdominoplasty flap ischemia (reduction of blood flow), interference with incision inspection and management, etc. These are all problems related to ill-fitting and/or inelastic compression garments. Patients must be carefully measured for a custom-fit garment preoperatively, and garment fit must be carefully monitored postoperatively. If a one-size larger or smaller garment is needed, we discontinue the current garment and have a new one sent by overnight delivery to the patient’s home. I am not dogmatic about compression garment use. If a patient states that they would prefer not to wear it, or would prefer to discontinue its use early, we allow the patient to do so. That being said, the vast majority of our patients wear their garments for the full four-week protocol, and some use them for longer than four weeks on their own volition. Garment fit and comfort is everything. If the fit is right and the patient is comfortable, then patients feel better, have a more pleasant recovery, experience less edema and more rapidly return to normal activity. Another important consideration: there is no convincing evidence that the use of compression garments reduces the rate of hematoma or seroma after abdominoplasty. The most important consideration with respect to avoiding postoperative hematoma and seroma is this: following your surgeon’s activity restrictions to the letter. Excessive early activity and too rapid a return to exercise definitely increases your hematoma and seroma risk, so make sure that your surgeon has carefully outlined a plan for your return to activity. Our recommendation for abdominoplasty recovery is this: Walking only for the first two weeks (casual, non-exercise walking). Walking is highly encouraged and the amount is not restricted, as long as it is casual walking. Light, non-impact aerobic exercise in weeks three and four – an elliptical trainer is ideal, and initial use should be brief and low-effort. Effort can gradually increase through the end of week four Gradual return to usual exercise regimen in weeks five through eight, with unrestricted activity at the end of week eight.