Drains vs No drains tummy tuck?

The use of drains is needed unless some measure to prevent fluid collection is taken.  If more than 80 cc of fluid collects, it may increase the risk of complications and need for needle aspiration of seromas. Preventive measures can include drains remove fluid, tissue glue, or progressive tension sutures. When progressive tension sutures are used, there is less than 80 cc of fluid total by ultrasound and it is  sequestered between the sutures in the study mentioned here. I routinely use progressive tension sutures which completely close off the dead space, with the result that there is no clinically detectable or significant seroma or fluid collection.
This results in  rapid adherence of the flap to the abdominal wall, and no concern that early ambulation and movement will result in shearing that opens a space for fluid to collect. The patient is more mobile, more comfortable and healing is hapid. Most patients are able to go back to sedentary work in 1-2 weeks.
 A meta-analysis in the Aesthetic Surgery Journal, 

Aesthet Surg J. 2017 Mar 1;37(3):316-323. doi: 10.1093/asj/sjw192.

Seretis K, Goulis, D, Demiri EC, Lykoudis, EG

Prevention of Seroma Formation Following Abdominoplasty: A Systematic Review and Meta-Analysis

reviewed all the literature on this topic, and found that "preventive measures" decreased the incidence of seroma four-fold. However one of the studies included in the "preventive group" that used only progressive tension sutures, from 2006, showed fluid accumulation between the sutures, detected only on ultrasound. This fluid was not clinically detectable by palpation or inspection and resulted in no need for seroma aspiration or any complication. The total amount of fluid associated with clinical complications in the other groups was greater than 80 cc, and the total amount of non-clinically detectable fluid in the progressive-tension group was always 80 cc or less. The use of drains plus progressive tension sutures did not change the amount of fluid.

The study was discussed by Pollock and Pollock, who noted that in their series of 565 patients using progressive tension sutures they never had a clinically significant seroma. When a seroma occurs, it may require multiple visits and aspirations, and if persistent, introduction of antibiotic sclerosing solutions, or reoperation to remove a fluid filled fibrous cavity. The drain opening may leave a scar in the incision or pubic mons which may become pigmented or depressed. Not having to use drains spares the patient and plastic surgeon from the chance of these undesirable events and/or outcomes.

My experience mirrors that of Drs. Pollack.  I have had no clinically significant seromas while using progressive tension sutures in the past five years or so. I have had one that responded to two aspirations, and one in patient with a high BMI that cleared with office placement of a seroma cath, with complete resolution.

Rather than use the 15-20 individually-placed sutures described by Drs. Pollock, I completely close the dead space with continuous PDO and monoderm Quill sutures. These sutures effectively reduce the dead space to almost nothing, so even the small amount of fluid that might collect between the sutures, cannot create any significant seroma. Using running Quill sutures allows relatively rapid dead space closure as no knot-tying is needed. The umbilical location is confirmed with a Lockwood flap marker before the lower abdominal closure is completed.

                                                

It is a safer and more consistent approach to use drains since an accumulation of fluid can lead to increased scar tissue, many more office visits, drainage of fluid by needle aspiration, possible placement of a drain during the recovery period, chronic seroma, etc.  I'm not saying that this happens every time when a drain isn't used but it's a higher risk. 

Hello and thank you for your question.  The
best advice you can receive is from an in-person consultation.  I use two drains for a tummy tuck.  In my experience, this and several other techniques can decrease the seroma risk.   Make sure you specifically look
at before and after pictures of real patients who have had this surgery
performed by your surgeon and evaluate their results.   The most
important aspect is to find a surgeon you are comfortable with. I recommend
that you seek consultation with a qualified board-certified plastic surgeon who
can evaluate you in person.
Best wishes and good luck.
Richard G. Reish, M.D.
Harvard-trained plastic surgeon