I'm considering a tummy tuck. Are drains better than progressive tension sutures?

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. Any extra fluid may be reabsorbed back into the body without the use of drains.  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. 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. Your board-certified plastic surgeon will recommend the type best suited for you. The most important decision to be made before performing any surgical procedure is determining whether you are an ideal #candidate.

Plastic surgeon performing tummy tucks for more than half a century years have used drains. Recently a technique has been slowly becoming more popular using Progressive Tension Sutures (quilting stitches) to attach the superficial skin/fat to the deep muscle layer below to prevent fluid accumulation that a drain would otherwise remove. It is not fool proof (nothing is), takes a bit more time under anesthesia to place these stitches and a girdle is generally worn immediately but a drain-less Tummy Tuck seems to work well. Patients tend to like this as there is no drain care and they can shower earlier. There may be slightly more swelling, more of a chance for seroma in some but in the long run (after 1-2 months) no difference in the swelling of those with and those without drains. On the other hand use of drains in my experience is a quicker operative time, early on prevents seroma and minimizes bruising, easy and painless to remove postoperatively, no need to wear the elastic garment/girdle until the drains come out in my practice.For those patients who choose another surgeon, the question to drain or not to drain is at the surgeon's discretion. There is no consensus at this point though most surgeons still favor drains until the output is generally about 30cc/24 hours. I individualize and if little or no liposuction at the time of a tummy tuck, a minimal or mini-tummy tuck I often do not use drains, whereas for significant liposuction with a tummy tuck and other procedures (#MommyMakeover) I most often use drains but individualize as needed.

I am afraid that the answer to this question is: It depends.  In general, the larger the amount of skin and fat that has to be removed the greater the likelihood that drains will be needed.  The use of progressive tension sutures alone, without drains, is best reserved for very slender patients with an excess of mostly skin as opposed to fat. 

Using progressive tension sutures helps prevent fluid collection, helps contour the abdomen, keeps tension off the scar for a nicer result, and prevents the scar from pulling up.  The key to a successful abdominoplasty result is a beautiful belly button and a low hidden scar; the progressive tension sutures help that happen. I think it is great to use progressive tension sutures in most cases...not just for the drains but for the beauty of the final result from your tummy tuck.  Dr Rodger ShorttOakville Plastic SurgeonAss't Clin Professor &Director of Cosmetic Surgery Training,McMaster University

Most patients tend to find the drains bothersome so I personally do almost all of my tummy tucks without them. Some people are not candidates for drainless TT for one reason or another however and without examining you it is difficult to advise which procedure would be better for you. In general there are many advantages to a drainless tummy tuck:No pesky drains and collection bulbs to manage for a week or longer post-opNo painful drain-holding sutures in your pubic area for as long as your drains are inNo additional wound care of the drain sites after they are removedNo additional scars from the drain siteThe ability to remove more abdominal wall skin when progressive tension sutures are used.The only real potential disadvantage for a drainless tummy tuck is:A theoretical increase in the risk of a fluid collection forming (most studies show this is not the case when the procedure is done properly.)As you can see, the advantages greatly outweigh the disadvantages and that is why I personally do not use drains whenever possible and many surgeons who do are switching to a drainless technique.

Hello, very good results can be achieved doing a tummy tuck with or without drains.  However, since I have switched to using progressive tension sutures and not using drains for most of my abdominoplasty operations I have been very happy with the results, and my patients are pleased not to have to deal with the drains.  That stated, an excellent outcome with tummy tuck surgery depends on so much more than this one issue so I would suggest choosing a surgeon on their overall skills, experience, and results.

Thank you for your question.  Both options are reasonable.  There is little scientific evidence that one approach is clearly superior to the other.  Drains are uncomfortable, but effective and the standard of care.  Progressive tension sutures are comfortable but have issues if not done well.  Best wishes.

Hi jimcitygirl,  I have been using progressive tension sutures for several years now and find that they have definitely improved my results and my patients post op recovery.  The sutures are designed to distribute the tension over the entire abdomen and not just at the incision. By decreasing the tension on the incision they help improve the scar.  They also eliminate the need for drains which are cumbersome painful and have a higher incidence of seroma. Patients also experience less discomfort. during your consultation the procedure will be explained in detail and your questions would be answered. Thanks for the question. 

Very successful tummy tuck results can be had whether drains are used or not. Each method of managing the tummy tuck 'dead space' has its advantages and disadvantages. Your surgeon should educate you on these differences so you can make an educated decision. It os not a question of one being bette than the other, each can be successfully used. 

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