Are all patients candidates for a drainless tummy tuck?

In my practice 99.9% of all patients are candidates for a drainless tummy tuck. I have not been using drains for 10+ years, and, in my opinion, there is no downside and all upside. There is no higher occurrence of a seroma (fluid collection) that has to be drained. In fact, I have noticed FEWER instances in seromas since I stopped using drains. If, after explaining my technique and philosophy to a potential patient, if they still wanted a drain, I would place one, but again, I find them completely unnecessary.

Most patients are candidates for a drainless tummy tuck.
Our meta-analysis (link below) revealed that a "drainless tummy tuck (abdominoplasty) with progressive tension sutures" was more effective than the traditional "tummy tuck with drains" in reducing seroma (fluid buildup) and reoperation rates, with no significant difference in hematomas or infections.
Despite these findings, many plastic surgeons continue to use drains during tummy tucks (typically since they were trained to use drains and continue this standard practice). Drains are typically used to prevent fluid accumulation under the skin, a common issue after the procedure. Fluid buildup, known as a seroma, can slow the healing process and lead to complications. Drains help remove this fluid, ensuring proper healing and minimizing complications. However, drains can be uncomfortable, require extra care, and increase the risk of infection at the insertion points. They can also leave scars, even after removal.
The introduction of the "drainless" tummy tuck, typically performed with progressive tension sutures, offers a promising alternative. These sutures close any dead space in the skin flap, significantly reducing fluid buildup and seromas. This technique eliminates the need for drains, which can lead to faster recovery times and less post-operative discomfort. While effective, this method has some challenges, such as a slightly longer surgical time and the need for a skilled and experienced surgeon. Some surgeons may still opt for drains, particularly in patients with certain body types or those undergoing significant liposuction, due to concerns about fluid accumulation. However, as evidence supporting the benefits of drainless tummy tucks continues to grow, this approach is gaining popularity for its improved patient comfort and smoother recovery process.
Though not all patients are ideal candidates for the drainless technique, it has proven to be a highly effective option. To ensure the best outcome, it's essential to consult with a plastic surgeon experienced in this technique. Incorrect placement of the sutures can lead to contour deformities or dimpling, and may require reoperation. Be sure to speak with a qualified surgeon to determine if a drainless tummy tuck is right for you!
Krishna Vyas, MD, PhD, MHSHarvard, Hopkins, & Mayo Clinic Trained Aesthetic Plastic SurgeonNew York, New York

Most patients do very well with progressive tension sutures in lieu of drains in my practice. The patients that have subsequently developed seromas have almost all been massive weight loss patients and patients that have had either a fleur de lis or extended abdominoplasties. So while there is a risk of developing a fluid collection without drains, most patients do not have this issue. 

Everyone who is a candidate for a tummy tuck is a candidate for a drainless tummy tuck.  However, not every surgeon has been trained in how to perform it or don't feel comfortable performing it and continue to use drains because that has worked for them for years. Numerous studies have shown a decrease risk of fluid collections (seroma) when performing one type of drainless tummy tuck regardless of wieght.   I prefer the progressive tension suture (PTS) technique for this reason. However, some surgeons will use TissueGlue in order to not use the sutures, however liposuction will increase the risk of seroma when the glue is used which is not the case with the PTS technique. Regards,

I think it depends on the patient. Most patients with normal body weight tend to be good candidates. Larger patients tend to form seromas more easily and may require drainage.With progressive tension suturing, which quilts the abdominal wall down, there is less fluid produced in all patients, regardless of a drain.

The choice to go with drains or drainless tummy tuck is the judgement of the surgeon.  Large BMI patients seem to have a higher risk of seroma many surgeons will choose drains in bigger patients.  I have many years of experience with drains, 3-4 years of experience with drainless, mostly progressive tension sutures and a few tissue glue drainless.  While any one of these can develop a seroma, most don't!  Most drainless tummy tucks do not need needle drainage.  Drainless tummy tucks are a huge improvement over drains.  Find a PS who has experience in going drainless.  

Hello and thank you for your questions. Every tummy tuck patient is a candidate for the drainless technique. It is a different technique than the traditional tummy tuck. The difference lies in how you close the wounds. For surgeons who do not perform this technique, if they were to not place drains then you would surely develop a seroma and have to drain the fluid with syringes in the postoperative period. However, for those who perform the drainless technique, there is no need for drains, which makes your recovery a lot smoother. If you want a drainless tummy tuck and your surgeon does not know how to perform that technique then you should find a surgeon who does.

Our published experiences at Marina Plastic Surgery in peer reviewed journals confirm that Drainless TT’s with Progressive Tension Sutures are actually better than TT with drains.   Good luck 

Many thanks for your question.
In my general experience most people are candidates for drainless tummy-tuck, although I would echo the comments of other surgeons that in massive weight loss patients there is some times a precautionary need for a drain - simply to give peace of mind to the surgeon more than anything else.
Drains were originally introduced to prevent collections of blood (haematoma) and fluid (seroma), however it has long since been well documented that this is not actually the case. I therefore find that drains are placed based on what has been taught over the generations from teacher to pupil and is 'eminence not evidence' based.
Even with drains patients still develop serums that require draining by way of passing a needle through the skin and soft tissues in to the collection and aspirating the fluid off with a suction drain or syringe - there is no difference in the incidence of this occurring between no drain and drain groups.
The negative side of drains are that you have to carry them around with you, sometimes up to 1-2 weeks, they are a potential source of infection and they are also uncomfortable whilst in you and also when they are removed!
I hope this helps you and I wish you all the best with your decision, but remember, the choice ultimately is yours - it is your body and we, as Board Certified Plastic Surgeons, are here to advise and help.

Drainless tummy tuck is a great procedure that works well in most patients.  It allows for less frustration and pain that come with the use of drains.  The only patients that I am reluctant to do a drainless tummy tuck on are patients that have had massive weight loss, or if they are larger patients at the time of the tummy tuck.  In my experience it has been quite rare to have problems with fluid building up after a drainless tummy tuck (seroma).  The incidence of seroma in my practice is actually lower after drainless tummy tuck than it is for patients that had drains placed.  Seromas can develop after drains have been removed.  I certainly feel like drainless tummy tuck not only makes care easier after surgery, but the progressive tension sutures that are placed to avoid drains also result in improved contour of the abdomen and improved appearance of the scar after surgery.  I feel that it is well worth the small amount of extra time in the operating room to make the recovery and result better for my patients.