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

I would focus less on the few days you will have the drains in, and more on the expertise and artistry of your surgeon.  That matters more than some irritation in the short-termBest of luck!
Dr. SubbioBoard-Certified Plastic SurgeonNewtown Square/Philadelphia, PA

Hello,
Drains are often used with a tummy tuck to drain excess fluids from the body. When drains are not placed, patients are at a higher risk for fluid collection under the skin, called a seroma. Overall, drains can help you avoid many complications including increased scar tissue, seromas, more office visits etc. If you have any questions regarding this topic, consult with a board certified plastic surgeon. Best of luck!

Most surgeons use drains after a tummy tuck. The use of drains will get rid of the excess fluid that would accumulate in your body. Without these drains, you are more likely to develop a seroma, which is a collection of fluid. Typically drains are removed 1-week post-op by your surgeon in the office. 

Drains are often used in tummy tuck, some doctors use sutures or tissue glue to avoid drains. The drain removes excess fluid, just because a drain is not used doesn’t mean fluid will not collect. If you collect fluid after surgry you may need to have it drained in the office with a needle. The best candidate for no drain are thin patients. Good luck. 

Thanks for your question. The use of drains is very common after a tummy tuck, and they are used by most surgeons. The drains are typically left in place for 1 week after surgery, when they are removed in the office. The risk of doing the operation without surgical drains is that you may be slightly more likely to develop a fluid collection (called a seroma) post-operatively. Take care. 

The reason we place drains in any surgery including tummy tuck is that when surgically we create a cavity in the body, the natural response is to fill it with clear fluid which is mostly made of proteins. Now this continues until the cavity is scarred down and healed. By placing drains we keep this fluid out until the layers in your tummy heal and scar down. It can take 1 - 3 weeks depending on how large the area is.
In no drain tummy tuck, we tack down the layers of abdomen with sutures so that there is much less separation of layers and hopefully no room for your body to create the fluid called seroma until everything heals. 
Now in my experience, no drain TT patients stay swollen for much longer time. To me 2 weeks of discomfort from drains is well worth the faster resolution of swelling.  

Thank you for your question, it's an important one!
The number one complication after tummy tuck is seroma formation. A seroma is a fluid collection that forms at the site of surgery. When tissue is injured (or cut) during surgery, fluid will seep out. Most of the time, the body is able to resorb the fluid. Because tummy tucks raise the skin flap a long distance from the incision and disrupts the lymphatic drainage, more fluid is generated than in other surgeries. This fluid tends to collect in the most dependent areas - namely, at the incision or in your pubic area. If left undrained, the fluid can get infected, the incision can open up, and/or the tissue around the fluid can form a shell or capsule to traps the fluid inside, making it even more difficult to treat. 
Drains have been the standard of care for many years now. They work! But you're right, they can be very frustrating to the patients and their caregivers. Drains usually stay in for 7-14 days depending on how much fluid comes out. And while the risk is small, the drain sites could also scar.
Drainless tummy tucks use progressive tension sutures to tack down the skin to the abdominal wall so that there is less dead space for fluid to collect and what does form is resorbed by the body. Research has shown that using these sutures is an effective way to prevent seroma formation without having to place drains. If you do form a seroma, your surgeon will drain it in the office.
Drains and sutures do not add cost to the procedure unless one requires more time.
Recently a tissue fibrin glue has been developed for drainless tummy tuck. However, there is not enough data yet to support its use and not everyone is a candidate. Also, this is an additional cost to the patient.
Generally, what your surgeon offers is what he/she is most comfortable doing (which for you means safest option!). Make sure you consult with a qualified plastic surgeon who can answer your questions fully and guide you towards what's best for you. I hope this helps. -Dr. Leong