How to decide between drainless vs drains?

I will preface my answer by saying I do primarily drainless abdominoplasties. With that being said I think both techniques are very effective and as others have mentioned you should choose the surgeon you trust and get consistent results. The complication profile between the two techniques when done correctly is very similar, specifically the risk of seroma formation. Some studies actually showed a decreased risk of seroma with the drainless.
Some patients just have a significant aversion to drains for a multitude of reasons; pain, squeamish about bodily fluids, anxiety about drain removal, the headache of recording drain outputs, restrictions on showering after surgery, etc. For these patients the drainless technique will provide great benefit.
I strongly disagree that you "cannot pull as tight" with the drainless technique. The progressive tension sutures that make the drainless technique possible actually offloads tension on the incision allowing you to pull the flap very tight.
I will be the first to admit that there are tradeoffs with the drainless technique. Most notably, increased operative time to place the progressive tension sutures (usually 15-30min). There can also be temporary dimpling of the skin in areas of the progressive tension sutures but this goes away within a few weeks. There are also rare circumstances during surgery that I may feel inclined to leave a single drain for a few days but this is uncommon.
You should go with your gut and choose the surgeon you are most comfortable with. Best of luck with your decision!

This is an excellent question. In short, it appears that you are happy with the results you have seen from both surgeons, so either way, it is unlikely that you would make a mistake in your choice of surgeons. That said, there are advantages to each technique, with drainless coming out ahead.

1. In a traditional tummy tuck, drains are necessary because after the removal of the excess abdominal tissue, the remaining abdominal skin is stretched down to the level of the lower abdominal incision without closing the open space between that tissue, and the muscle layer. So, there is a space there where fluid can collect. By placing drains, that fluid is removed, and the two layers can heal together.

2. In a drainless tummy tuck, the above-mentioned space between the abdominal skin, and the muscle layer is eliminated (closed) with sutures, placed in a quilting fashion. Therefore, there is no need to place drains that remove fluid because there is not a space in which fluid could collect.

Advantages of a traditional tummy tuck:
- there is less sewing to be done, so it is a bit faster. But not by much.

Disadvantages of a traditional tummy tuck:
- the obvious disadvantage is drains. They can be uncomfortable, and generally, what patients complain about the most.
- drain hole scars. But, these are relatively minor.
- A lower abdominal scar that migrates up as you heal. This is probably the biggest disadvantage. The upper abdominal skin, which was pulled down tight, wants to pull back up as it heals (think window shade). Because there are no sutures anchoring it in place, it can actually move the lower abdominal scar higher as the patient heals. The tighter the closure, the more likely that this may happen.

Advantages of a drainless tummy tuck:
- no drains
- no drain scars
- better mobility early on after surgery
- generally a better shaped, and better positioned lower abdominal scar when healed. There is no upward scar migration.

Disadvantages of a drainless tummy tuck:
- It takes slightly longer to perform the surgery
- In the first 1–2 weeks, you may see the impression of the quilting sutures on the skin. But as that initial swelling goes down, these disappear. This is a non-issue long-term.

I hope this helps. Dr. B.

Hi there- both drain and drainless work, and you can get the same amount of tightening from both. Drainless has a lower rate of seroma based on the published data