Drain Still in and Draining Mostly Blood 14 Days After Tummy Tuck, Should I be Concerned?

Question

I had tummy tuck and breast lift/augment surgery 14 days ago. Recovery has gone great except my drain in abdomen is still putting out 75 cc a day or more and it's still very bloody looking. I can't say that i have seen a change in the red color since we started this journey. I understand this drainage color is related to the stage of recovery of the site. I am concerned that something may be wrong. I saw my surgeon 4 days ago and she did not seem overly concerned, but I am a little.

Jonathan Saunders, MD · Answer

a little bit of blood can make drainage fluid appear quite red. drainage after 2 weeks is not the norm .but can happen without it being alarming. why dont you check your blood count and see where you stand. i would rather have the drains in too long than too short. aspiration later on is an irritation to everybody involved.

Don W. Griffin, MD · Answer

You may have had a hematoma that is now liquefying and coming out of the drain. This tends to look a deep red or brown color, not bright red which would indicate active bleeding. Continue to be seen by your surgeon.

Gary Motykie, MD · Answer

It is normal to have a
little bit of drainage after the drain has removed.  The skin wound will need a few days to fully
close and until that happens some fluid can leak.  However, there should not be a large amount
of drainage, nor bright red blood.   If
this happens, go see your surgeon immediately.

Pablo Prichard, MD · Answer

Thank you for your post.  Whenever there is a potential space in your body, your body tends to fill that space with serous fluid (the yellow type of fluid that also comes out of a 'weeping wound'.  This is similar to when you get a blister: the layers of skin separate and fluid is deposited in to the space.  In a tummy tuck, the space is in between the skin/fat layer and the muscle layer.  Most surgeons will place a drain to remove this fluid while your body is secreting it until the fat layer grows back together with the muscle layer.  At that point, no more fluid is secreted into the area, because there is no more space for fluid.  The length of time that this takes varies from patient to patient.  Some patients heal much faster, thus the layers seal together much faster.  Also, the more twisting motion you have in your belly area, the slower the two layers grow back together because they are moving in relation to each other.  The fluid coming through the drain can be initially dark red, and eventually clears to pink then yellow.  This is because it takes just a little bit of blood to make the fluid dark red.  Also, initially, there can be a large amount of fluid (few hundred cc's in the first day is not out of the range of normal) and this should slow down substantially over next few days.  Once the fluid slows down to the amount that your surgeon is comfortable with (usually 25-50 cc in 24 hours) then they will be pulled. There is minimal discomfort in pulling the drain in most patients.  More recently, 'drain free' surgery has become more popular. Fat layer is sutured down to the muscle layer starting at the ribs and progressively down to the lower incision.  This makes the space for the fluid to collect much smaller, and in many patients can have surgery without drains.  However, I have seen multiple patients come from other surgeons because they developed a seroma despite the suturing of the tissue.  This is not the surgeon's fault, but some patients just do not heal fast enough or put out too much fluid for the body to absorb. Blood looking drainage 14 days out should be examined by your plastic surgeon.  It is quite likely that it is just blood tinged rather than actual blood. Best wishes,Pablo Prichard, MD

Steven Turkeltaub, MD · Answer

Drain tubes can be left in for several weeks and I have seen this. Though 75cc/24 hrs is high, it is not necessarily representative of a problem. Is the blood a light or dark red? Are there clots? Is it decreasing somewhat? Is the color lightening up to some extent over time?

	Answers to these questions are important. They can also help determine if you have active bleeding or even an "old" hematoma that is dissolving.

	Keep in close follow up with your plastic surgeon.

Robert L. Kraft, MD, FACS · Answer

This is a high drain output for 2 weeks postop but would not be unprecedented.  You may be draining a hematoma but, because there is a concern about continued bleeding, you should see your plastic surgeon in followup and inquire about the color of the drainage and the expectation for removal of the drains.

Darryl J. Blinski, MD · Answer

The issue is "bloody looking". Is it BRIGHT RED or is it darker more liquid? Are there clots? These are questions and in person observations that I make to determine if you are bleeding. Best to be seen more often by your chosen surgeon.

Tom J. Pousti, MD · Answer

Thank you for your question.

	Although the drain output is still somewhat high 2 weeks after surgery it is not necessarily alarming unless there is active bleeding present.

	I am glad you are following up closely with your surgeon because she is in the best position to evaluate the consistency and amount of drainage. Her advice and/or reassurance will be much more precise than that provided by online consultants.

	Don't hesitate to address your questions and concerns with her.

	Best wishes.

Robert N. Young, MD, FACS (retired) · Answer

It's not unusual to have the drains in place after two weeks. Usually the fluid is blood tinged and not pure blood. I would have another followup with your surgeon, who is in the best position to determine whether there is anything to be concerned about. She can look for potential problems.

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