Drains vs. no drains with a Tummy Tuck, what are the differences?

Some doctors insert drains after a TT for 1-2 weeks and another consultation told me he doesn't use drains but rather uses a different suturing procedure that doesn't require drains. I would rather not have drains but wonder where does all that extra fluid go that would normally drain out of the drain? Will I be more swollen without a drain? Is this a newer technique or a gimmick?

Doctor Answers 18

Drains Vs No Drains

The use of drains during abdominoplasty is really a choice of surgeon's personal preference.  I routinely perform liposuction of the entire abdomen to help the contour during abdominoplasty.  I find that I can get a better shape and improve the midline and flanks.  In my hands, this helps create an hour glass shape and "etches" to define abdominal wall musculature.  It also helps prevent contour abnormality and a smooth transition between the thick upper abdomen skin and the thin groin skin.  I also use a quilting suture technique to collapse space, contour the midline, and decrease drainage.

All that being said, I prefer to use closed suction drains.  I prefer not to use an abdominal binder or compression garment during the first week, in part due to the concomitant use of liposuction.  Liposuction thins the subcutaneous fat, but also disrupts some of the blood supply and causes additional fluid drainage.  I feel that it is safer to not compress the abdominal skin after abdominoplasty with liposuction (especially at the midline) during the first week or so.  In my hands, I feel that this creates a better more sculpted result.  Additionally, patients are sometimes placed on blood thinners in order to decrease embolic risk, which I feel further justifies drain usage.  

Personally, I wouldn't pick a plastic surgeon based on whether or not they use drains but rather decide based on their results and reputation.

Absolutely, see a board certified plastic surgeon for any abdominal contouring procedure.


Miami Plastic Surgeon
5.0 out of 5 stars 24 reviews

Drains with Tummy Tuck

There are two approaches to treatment of the flap (the skin and fat of the abdomen) after an abdominoplasty. One utilizes drains to hold the flap to the muscle and the other tacks the flap to the muscle with multiple sutures. If you read the literature, the seroma (fluid collection) rate is about the same in each. The other risks, though slightly different, are also essentially equivalent. Therefore, the choice boils down to individual surgeon choice. Personally, I still use drains. My seroma rate is practically zero, which is below what is reported for both methods and my experience with the suture method. I also use drains, not only to prevent seromas, but to, hopefully, reduce swelling. This has definitely been proven in facelifts, though it has not been proven yet in tummy tucks. 

Robert T. Buchanan, MD
Highlands Plastic Surgeon
5.0 out of 5 stars 5 reviews

Drains vs. No drains with Tummy Tuck

This is a very good question and is frequently a topic at our national meetings. It has been shown there is a benefit to placing deep sutures under the skin to try to anchor the skin flap down to the underlying tissue. This adds some extra time to the surgery but it has decreased the seroma rate of abdominoplasties. Placing drains afterwards should also decrease the seroma rate but some recent studies have shown this is questionable. I think it is surgeon preference and pros and cons/ risks and benefits need to be discussed prior to surgery.

Mark Deutsch, MD
Atlanta Plastic Surgeon
5.0 out of 5 stars 28 reviews

Drains are a valuable adjunct in the early healing of a tummy tuck

Your question is a good one. Drains are used to remove potential fluid from a space that has been widely dissected, such as a tummy tuck. The drains also produce suction so that early after the surgery there is no potential for having the tissues move back-and-forth creating a shear force that would cause more fluid production. Some doctors use what is called progressive suturing which creates an artificial adherence between the deep and superficial tissues during the closure of a tummy tuck. Sometimes we don't need drains with this technique. The fluids are absorbed by the body and the abdominal binder controls excess swelling. 

In my view, drains are valuable in the early recovery of a tummy tuck and minimize the chance of hematoma or seroma, a collection of blood or fluid under the skin. Drains are rarely in for more than a week, and can be removed without pain. Like many things, to have it and not need it is better than to need it and not have it.

John Cassel, MD (in memoriam)
Miami Plastic Surgeon
5.0 out of 5 stars 10 reviews

Do you need drains after tummy tuck?

Many plastic surgeons today still use drains after tummy tuck.   The use of drains is a time proven method to remove excess fluid from beneath the abdominal skin and prevent seroma and hematoma buildup.  In my practice I always use drains which are usually removed by day 2 or 3 and the drain sites are within the pubic hair so that they're not visible after healing.

Suturing the abdominal flap down to the muscles is a newer technique that plastic surgeons use instead of drains.  The theory is that by closing the extra space beneath the skin between the skin and muscle that this will prevent fluid buildup and make drains unnecessary.

The most important thing is that you have confidence in your plastic surgeon.  Choose your plastic surgeon based upon the surgeon's expertise, skill,, and empathy and relationship with you.  Once you've chosen your surgeon then let the surgeon decide the best method to use.

About No Drain Tummy Tucks

Thank you for your question.

During a tummy tuck surgery, there is space between the abdominal wall and the overlying fat and skin (the abdominal flap). The body will do what it usually does during the healing process, produce fluid, if nothing is done to close this space. Because there is nothing to confine the fluid from accumulating, a seroma can develop in this space. In other words, the tissue produces fluid more quickly than it can reabsorb.

Negative suction drains are placed in spaces like this to get rid of the fluid and create suction between the tissue planes. There is a way, however, to eliminate this space without using uncomfortable drainage tubes. Dr. Patel utilizes progressive tension sutures inside the tissues to close off the space and relieve tension on the last surgical closure. This results into less pain, less discomfort and less tension. Also, there will be better scarring with potentially minimizes infection risk.

We have successfully used progressive tension sutures during abdominoplasty instead of surgical drains, with a lower seroma rate than is generally thought to occur with tummy tucks and drains. With this method, the seroma rate is close to zero and you cannot beat that approach. Best of luck!
Dhaval M. Patel

Double Board Certified

Plastic Surgeon

Hoffman Estates

Barrington

Oakbrook

Chicago

Dhaval M. Patel, MD
Hoffman Estates Plastic Surgeon
4.8 out of 5 stars 79 reviews

Drains or No Drains TT

The answers by the other posts are excellent and comprehensive. The idea behind drainless tummy tucks stems from using progressive tension sutures to effectively minimize the "dead space" and allow the flap to "stick" to the abdominal wall.  However, there is still fluid from liposuction and still a small possibility of seroma development.  In my hands, I use progressive tension sutures and use a small drain, but I remove them earlier (within a few days) than before.

Samir R. Shah, MD, FACS
Oak Lawn Plastic Surgeon
5.0 out of 5 stars 9 reviews

No Drain Tummy Tuck is the way to go, not a gimmick

Most surgeons still use drains because they were trained that way and they have been getting nice results with their technique. We used to get very nice results using drains as well.

However, we transitioned from using drains to the no drain tummy tuck procedure 4 years ago and the addition of this technique of the best things we have done for our patients. We used to use drains in order to supposedly prevent fluid collections after surgery (called seroma). It only takes an extra 15-20 minutes to place the progressive tension sutures in the operating room. The sutures prevent movement of the surgical site and close off the space so that fluid isn't made as much and it can not build up. I perform liposuction along with my no drain tummy tuck in almost every case, many times with significant amounts of liposuction reaching the limit of 5 liters and still do not use drains. 

In a study we conducted in over 450 tummy tucks over 7 years we found the the seroma rate was 9% when drains were used and it dropped to 2% when the no drain tummy tuck procedure was introduced to our practice. Regarding the swelling you are asking about, we did not look at that in the study in particular, but it does not appear that parients look any more swollen after transitioning to the no drain technique. 

The drains are not only annoying to care of for 1-2 weeks, they are painful at the exit site, are a possible source of infection and always leave some additional scar (even if they come out the ends of the incision). I hope this helps and best wishes.

Drains Vs No Drain TT Decision


Plastic surgeon performing tummy tucks for more than half a century years have used drains. Recently a technique has been slowly becoming more popular using Progressive Tension Sutures (quilting stitches) to attach the superficial skin/fat to the deep muscle layer below to prevent fluid accumulation that a drain would otherwise remove. It is not fool proof (nothing is), takes a bit more time under anesthesia to place these stitches and a girdle is generally worn immediately but a drain-less Tummy Tuck seems to work well. Patients tend to like this as there is no drain care and they can shower earlier. There may be slightly more swelling, more of a chance for seroma in some but in the long run (after 1-2 months)no difference in the swelling of those with and those without drains. On the other hand use of drains in my experience is a quicker operative time, early on prevents seroma and minimizes bruising, easy and painless to remove postoperatively, no need to wear the elastic garment/girdle until the drains come out in my practice.
For those patients who choose another surgeon, the question to drain or not to drain is at the surgeon's discretion. There is no consensus at this point though most surgeons still favor drains until the output is generally about 30cc/24 hours. I individualize and if little or no liposuction at the time of a tummy tuck, a minimal or mini-tummy tuck I often do not use drains, whereas for significant liposuction with a tummy tuck and other procedures (#MommyMakeover) I most often use drains but individualize as needed.

#DrainsvsNoDrainDecision

Drains vs. no drains with a Tummy Tuck, what are the differences?

Thank you for the question. It is extremely common to receive different opinions from different plastic surgeons about the best way to treat a specific “problem”. Each plastic surgeon may have his/her opinion that is based on their specific/unique education, experience, and personal preferences. Their opinions may also be shaped by unfavorable results they have encountered in their practices.
Although these different opinions can be confusing and a source of anxiety for patients, it is good for patients to understand the different options available. Ultimately, it will be up to each patient to do their due diligence and select their plastic surgeon carefully. Part of this selection process will involve the patients becoming comfortable with the plastic surgeon's experience level and abilities to achieve their goals as safely and complication free as possible.  In my practice, I  currently use drains  for all tummy tuck patients; I also use progressive tension sutures for most patients.
I hope this, and the attached link (dedicated to tummy tuck surgery concerns), helps.

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.