Why do some doctors choose to insert drains after a tummy tuck and others do not? What are the pros and cons to both?
Drainage After Tummy Tuck
Doctor Answers 18
Drains after 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.
After a Tummy Tuck, drains are your friends
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:
Issues with drains and tummy tucks
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.
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Use of drains in a tummy tuck
As Dr. Mckenzie indicated, the disection creates a large space between musculofascia and skin/fat. To be more precise it usually is about 36 sq. in.!! Properly placed and utilized drains can prevent the accumulation of fluid into this space and also aid in flap adherence.
I've used them for forty yrs and have never regretted it.
Tummy tucks and drains
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.
Tummy tuck is safe without drains
You will notice immediately that there are differing opinions about the need for drains after a tummy tuck procedure. The drains are placed by some surgeons because they feel that there is a lower risk of a fluid collection called a seroma after the procedure. There are many well recognized publications which demonstrate that drains are not necessary, and indeed in our practice we have not used drains on tummy tuck procedures for over seven years. Surgeons should practice according to their own belief, comfort, and experience. There is not a right or wrong answer to the drain issue, and a seroma can occur with or without one.
Best of luck.
Using drains with tummy tucks
During the dissection of a tummy tuck, a fairly large space is created between the abdominal wall and the fatty layer above it. This space has the potential to accumulate fluid until the layers heal back together. Although the compression garment helps, the fluid can be significant and is typically removed with drains placed at the time of surgery which remain in place for a week or two.
There are some tummy tuck techniques where internal stitches are placed to try and get the layers to heal together faster, reduce the potential space between the layers, and avoid drains. The problem is, it doesn't always work. Removing the fluid (called a seroma) which may accumulate even after the drains come out, or if they were never placed in the first place, involves sticking needles in your abdomen every few days until it stops, or placing a drain through the skin as a procedure done in the office.
I believe the most prudent course of action is to place drains at the time of surgery for a procedure like a tummy tuck.
Drains and Tummy Tucks
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.
Pablo Prichard, MD
Drains in tummy tucks
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.
Tummy tuck: To drain or not to drain?
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.
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.