Please explain the difference and possible risks for Tummy Tucks with or without drains. Thanks!

Doctor Answers 8

Please explain the difference and possible risks for Tummy Tucks with or without drains.

When a tummy tuck is performed, the skin and fat layer is elevated off of the muscle, the muscle is often tightened and the excess skin and fat layer removed. Until the skin/fat layer reattaches to the muscle, your body tissue will secrete fluid into this space creating a seroma if not dealt with. 

There are now three methods to deal with eliminating or evacuating the fluid in this space.

1. Drains physically suction the fluid out allowing the tissue to reattach. Once the tissue has reattached, the drainage lessens and the drains are removed.

2. Some surgeons use quilting sutures to reattach the skin/fat to the muscle in multiple places beneath the skin. This eliminates the potential space and hopefully the chance of developing a seroma. These sutures require more surgical time/cost and can create dimpling in the skin which will eventually go away as the sutures dissolve in 1 to 2 months. 

3. There is a new FDA approved tissue sealant (glue) called TissuGlu which can be applied to muscle before closing the skin. By a chemical reaction, the sealant adheres the skin/fat to the muscle, eliminating the dead space. The company says that it can eliminate the need for drains. I have used this on 5 patients to date and placed only one drain instead of two in order to determine whether I think that this product will completely eliminate the need for drains. I have noticed that these patients definitely have less drainage and the drains have been able to be removed sooner than in patients without the TissuGlu.

For completeness sake, a seroma can form no matter which option your surgeon chooses and the rate of seroma formation for patients with drains versus quilting sutures is the same. To my knowledge, there are no large studies yet on the TissuGlu to determine the seroma rate.

Difference and possible risks for Tummy Tucks with or without drains.

Drains and progressive tension suturing - PTS (quilting stitches) are both acceptable means of addressing the risk of fluid collection formation.  With every method, there are pros and cons.  Although the presence of drains may be a slight nuisance, it does a great and time-tested job of reducing the risk of collections.  The benefit of PTS is that you avoid the drains but your procedure may take longer and there may be more postoperative pain. Regardless, be sure to consult with a board certified plastic surgeon who is experienced in the procedure you're looking for.  Good luck!

Zachary Farris, MD, FACS
Dallas Plastic Surgeon
5.0 out of 5 stars 14 reviews

Drainless tummy tuck has one extra risk

Tummy tuck with or without drains have same risks. Drainless tummy tuck has additional risk of undrained fluid accumulation since there were no drains to let it come out.  Drainless tummy tuck however enjoys convenience of not having to deal with drain tubes. Let the decision of drains or no drains be made by the surgeon during surgery based on his/her judgement.  Patient concern should be the best way not the patient way for every surgery. Trust your doctor to do the right thing.
Other risks range from scars. loss of tissues, infection, of course seromas, blood clots, anesthesia risks and even death.   

Vasdev Rai, MD
Dallas Plastic Surgeon
5.0 out of 5 stars 21 reviews

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Tummy Tuck with and without drains

The two methods of closing down the space under the skin after a tummy tuck is to use quilting sutures or drains.  Some people use both.  Personally I have been using drains for years and have had only rare problems.  I don't think having drains is that big an inconvenience, whereas a seroma can be a big inconvenience.  It comes down to the experience and preference of the surgeon.

Please explain the difference and possible risks for Tummy Tucks with or without drains.

Some excellent plastic surgeons use drains, some use internal quilting sutures, and some use both. Whether a 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

Robert Singer, MD
La Jolla Plastic Surgeon
4.6 out of 5 stars 19 reviews

Tummy Tuck with and without Drains

There are 2 methods of dealing with the large open space under the skin/fat flap with a tummy tuck. One is to use drains to suck the tissues together and the other is to sew the layers together with multiple rows of sutures. Both work quite well and the choice is purely surgeon's choice. I personally like drains as I have had less problems with them, but surgeons who use the other method also get excellent results. Do not pick your surgeon based on how he/she handles this problem.

Robert T. Buchanan, MD
Highlands Plastic Surgeon
5.0 out of 5 stars 5 reviews

Drains and tummy tuck

Thanks for your inquiry.  Drains can help tissue adherence, reduce swelling, and prevent fluid collections, like seromas or small hematomas.  Drains involve woundcare and compliance by the patient which if not properly managed, could lead to issues, but I find most patients do an excellent job caring for them. Please pick the surgeon whose bedside manner and aesthetic results you like the most because the issues of drains or no drains is a short approximately 7-10 day process.  After that you are left with the final result forever.  Hope that helps, good luck. 

Difference and possible risks for Tummy Tucks with or without drains.

Thank you for the question. It is very common to receive different opinions from different plastic surgeons about the best way to treat a specific “problem”. Each plastic surgeon may have his/her opinion that is based on their specific/unique education, experience, and personal preferences.
The use of drains for tummy tuck surgery will vary from one practice to another; there is no "correct" answer. In my practice, I currently use drains for all tummy tuck patients; I ALSO use progressive tension sutures for most patients.
I hope this, and the attached link (dedicated to tummy tuck surgery concerns), helps.

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.