What are the pros and cons to using drains with a tummy tuck?

Drains are used after tummy tucks to remove excess fluid so it does not collect and need to be drained with a needle.
You can reduce the need for drains altogether by using fibrin glue. However it is a pool human blood product, and does not guarantee that fluid will not form. It also requires special consent forms because it is a blood product, and we do not use it for these reasons.
Some doctors advocate quilting sutures, but these can leave puckering marks and fluid can still form.
Almost all patients want a pain pump these days, so a tube is necessary to deliver the pain medicine anyway.
Nobody likes to use drains, but they serve a very good purpose given the alternatives.

When a tummy tuck is done, the skin and fat are surgically lifted off the underlying muscle layer. This creates a space into which serum and blood can collect after the surgery. Drains remove that liquid so that the two layers stick down to each other again. In the days after surgery, healing occurs and there is less serum leaking into this space, then the drains can be removed.
There are procedures that can be done to help the two layers stick together immediately, but these are associated with some increased risk in wound breakdown and infection, so I choose to use drains. Tummy tuck is a big operation and in my opinion, the added temporary hassle of drains is worth a safer outcome.

Hi there-
After a tummy tuck, there is a large space under your skin (the tunnel in which your muscles were tightened) that needs to heal in order for your body to achieve the best shape possible, and to prevent fluid from collecting (a seroma).
While some surgeons avoid placing drains by placing quilting sutures, it is my opinion that the increased time required to place these sutures and the increase in risks to your health that come from extending the length of the surgery are not worth the benefit of avoiding having drains for a few days.
Further, it has been my experience that while placement of quilting sutures can minimize the risk of seroma formation, this risk is still higher than when drains are placed.
Finally, I would strongly caution you against using this as a criterion for choosing a surgeon. Patients get themselves into all kinds of trouble when they start micro-managing the technical details of their operation.
The best advice I could possibly give you is to find a surgeon you like and feel you can trust- then TRUST THEM to do their very best to achieve your best outcome and minimize your risks.
Need advice on what you SHOULD be looking for in a surgeon? Read this:

The vast majority of surgeons still use drains. A small percentage do not. The reason for placement is to evacuate the space that is created between the muscle and skin. Surgeons who do not use the drains sew this layer closed with special stitches called quilting sutures.

As the other responses have explained, drains are used to prevent accumulation of fluid in a space where there has been dissection. Since a tummy tuck involves a lot of undermining in order to pull the skin tight, there is normally a lot of fluid buildup. However, there are some ways to minimize this, notably the use of what are called Progressive Tension Sutures. I started using them about 12 years ago and noted that drainage was way down so that we could get the drains out in a couple of days instead of about a week which is more typical. At the same time, a surgeon named Harlan Pollock (in Texas) started doing the same thing, and he no longer uses drains at all! I still use drains but I would definitely encourage you to find someone who does the PTS technique.

There is an old adage from biology that applies here 'Nature abhors a vacuum'- in other words, when a space is created in the body, that space will become filled with something if left alone.
During a tummy tuck procedure, a very large space is created between the abdominal soft tissue flap and the abdominal wall. Since this flap will be closed, its important to place drains in the space to reduce the collection of fluid that can occur.
The temporary discomfort and inconvenience of a couple of abdominal drains is certainly less of an inconvenience than a chronic seroma that requires drainage later on.

Over 50% of patients will have some element of a seroma (collection of fluid) after a tummy tuck. This fluid has to go somewhere and most patients would prefer it come out as opposed to walking around with a water balloon. The drains are inconvenient, awkward, and cumbersome but they are also, in most instances, necessary.

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. Best wishes,Pablo Prichard, MD

Most surgeons use drains to empty the fluid that tends to accumulate in the space created during the surgery. Without these drains, the fluid may accumulate and require drainage, which prolongs the healing process. Some surgeons will use a biological glue to close this space down, while others will use sutures to close it. This is really based on a surgeon's personal preferences and experience. Best wishes.

I agree with almost all the previous posts that drains are necessary after tummy tuck in order to have the fastest recovery and more importantly the best final result. There are very few plastic surgeons who do not use drains at all after tummy tucks. I wanted to add my voice to the overwhelming majority of plastic surgeons who use drains.