Risk of seroma higher with drainless tummy tuck?

Dear lindyshellp,
drains are used to remove fluid and prevent seroma. In case of drainless tummy tuck, the risk of seroma formation would be higher. If you are considering a surgery, I would suggest you to consult a board-certified plastic surgeon. Only after a thorough examination you will get more information and recommendations.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Our meta-analysis (link below) revealed that a "drainless tummy tuck (abdominoplasty) with progressive tension sutures" was more effective than the traditional "tummy tuck with drains" in reducing seroma (fluid buildup) and reoperation rates, with no significant difference in hematomas or infections.
Despite these findings, many plastic surgeons continue to use drains during tummy tucks (typically since they were trained to use drains and continue this standard practice). Drains are typically used to prevent fluid accumulation under the skin, a common issue after the procedure. Fluid buildup, known as a seroma, can slow the healing process and lead to complications. Drains help remove this fluid, ensuring proper healing and minimizing complications. However, drains can be uncomfortable, require extra care, and increase the risk of infection at the insertion points. They can also leave scars, even after removal.
The introduction of the "drainless" tummy tuck, typically performed with progressive tension sutures, offers a promising alternative. These sutures close any dead space in the skin flap, significantly reducing fluid buildup and seromas. This technique eliminates the need for drains, which can lead to faster recovery times and less post-operative discomfort. While effective, this method has some challenges, such as a slightly longer surgical time and the need for a skilled and experienced surgeon. Some surgeons may still opt for drains, particularly in patients with certain body types or those undergoing significant liposuction, due to concerns about fluid accumulation. However, as evidence supporting the benefits of drainless tummy tucks continues to grow, this approach is gaining popularity for its improved patient comfort and smoother recovery process.
Though not all patients are ideal candidates for the drainless technique, it has proven to be a highly effective option. To ensure the best outcome, it's essential to consult with a plastic surgeon experienced in this technique. Incorrect placement of the sutures can lead to contour deformities or dimpling, and may require reoperation. Be sure to speak with a qualified 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

You will get a variety of answers hear. The folks that do the drainless tuck will say its the same. The folks to put drains will say its higher. I prefer to leave drains. I don't think it is advisable to base your procedure choice on drains vs no drains.

The purpose of drains is to collect fluids from the abdomen as it heals after a tummy tuck. They are typically in place for 7-14 days and help to prevent seroma formation. Is it possible to have a drainless tummy tuck and not develop a seroma? Yes. However I use drains for my tummy tucks and rarely do my patients develop a seroma.

Yes, the risk of seroma is higher without drains. That is why many surgeons still choose to use drains for at least the first week.

surgeon uses drains or not should be one of the least important factors in choosing the surgeon. The choice of drains or no drains should depend on the extent of the procedure and the surgeon’s opinion based on his or her experience. Good results have been obtained both with and without drains. The length of the recovery and the extent of swelling are not diminished in procedures where no drains are used.

What is far more important is the choice of the surgeon. I would suggest you find a plastic surgeon certified by the American Board of Plastic Surgery and ideally a member of the American Society for Aesthetic Plastic Surgery (ASAPS) that you trust and are comfortable with. You should discuss your concerns with that surgeon in person. While a second or third opinion may be worthwhile, continuing to pursue consultations until you get the answers that you think that you want to hear may not necessarily be in your best interest. If you are ambivalent, don’t do the procedure.

Robert Singer, MD FACS

La Jolla, California

Thank you for your question. It has been over 12 years for me since I abandoned using drains with tummy tucks.

My personal seroma rate has gone down from about 30% to less than 1%. Of course we are talking about clinically recognizable or relevant seromas since I don't do ultrasounds on every patient.

In addition my infection rate related to tummy tucks has gone down at the same time since drains themselves can contribute to infection development.

So from personal experience and over 750 dreamless abdominoplasty I feel the risk for seroma and other complications is much lower.

Finally, I think my results aesthetically are also improved with the progressive tension cutting technique that is used in a drainless tummy tuck.

See an experienced plastic surgeon to confirm my opinion.

Avoiding drains with a tummy tuck.

Plastic surgeons who avoid drains after tummy tech have generally modified the procedure to minimize the chance of developing a seroma.

If a traditional tell me tuck is done and drains are not placed the patient will get a 100% chance of developing a fluid collection.

Whether the changes in technique potentially eliminating the need for a drain or using them less often is good or bad is going to vary based on who you ask.

Personally I would choose the surgeon based on who gets the best looking results and I would judge results based on who gets the most natural looking belly button with very low set scars that follow anatomic outlines nicely and don’t leave patients with “dog ears” or fullness in their love handles.

Whether a drain is used or not really isn’t or shouldn’t be a deciding factor in my opinion. there’s an expression in plastic surgery that goes “ i’ve never regretted putting in a drain“

When patients develop a seroma and a drain wasn’t placed (or was removed prematurely) it’s pretty miserable.

Best,

Mats Hagstrom MD