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

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.

Our meta-analysis research (link below) showed that "drainless tummy tuck (abdominoplasty) with progressive tension sutures" were more effective than "tummy tuck with drains" in reducing seroma (fluid buildup) and reoperation rates, with no difference for hematomas or infections.
Many plastic surgeons continue to use drains during tummy tucks because it has been the standard practice for many years. Drains are traditionally used to prevent fluid accumulation under the skin, a common occurrence after the procedure. The accumulation of fluid, known as a seroma, can slow healing and lead to complications. Using drains helps remove this fluid, ensuring proper healing and minimizing the risk of complications. However, drains can be uncomfortable, require additional care, and increase the risk of infection at the insertion points. They can also leave scars, even after they are removed.
The advent of the "drainless" tummy tuck, typically achieved through the use of progressive tension sutures, offers an alternative to this approach. These sutures help to close any dead space in the skin flap, significantly reducing the likelihood of fluid buildup and seromas. This technique not only eliminates the need for drains but can also result in faster recovery times and less post-operative discomfort for patients. While it has been shown to be highly effective, it is not without its challenges, such as a slightly longer surgical time and the need for a highly skilled surgeon to perform the procedure. Some surgeons may still prefer to use drains out of familiarity or due to concerns about fluid accumulation, especially in patients with certain body types or those undergoing significant liposuction. However, as more evidence supporting the benefits of drainless tummy tucks accumulates, this method is becoming increasingly popular for its enhanced patient comfort and streamlined recovery process.
While not every patient is a suitable candidate for a drainless approach, the procedure has proven to be a highly effective option. Your plastic surgeon needs experience in this technique, because incorrect placement of the sutures can cause major problems including contour deformities or dimpling and possible need for re-operation. Be sure to consult with an experienced plastic 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

Many plastic surgeons have dispensed with drains by sewing the abdominal flap back down to the abdominal wall.  This results in so little space for fluid to accumulate that drains are no longer necessary. Studies going back to 2006 have demonstrated the effectiveness of this technique if properly done. Less than 80 cc of fluid was found on ultrasound and this amount was reabsorbed and had no clinical significance, and was non-detectable by observation and palpation.Drainless tummy  tucks are an integral part of my procedure.  Even with drains or tissue glue there is a a 5-45 % incidence of seroma per the literature. 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. 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 including drainage 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, so there is really no benefit to using drains plus progressive tension sutures.

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.

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.

The drain is uncomfortable, can leave a tell tale scar, and is difficult to manage.  Without a drain the recovery is faster, easier, and more comfortable.

The #drainage tubes for a tummy tuck are used by trained Plastic Surgeons for many different operations. The purpose is to drain extra fluid which may otherwise accumulate under the skin, fat or muscle following an operation.  Patients generally find this annoying and uncomfortable and they can impede mobility and therefore slow aspects of #healing. Over the years, surgeons have improved procedures and found ways to eliminate the need for these #drains in a variety of operations; including #tummy #tuck or #abdominoplasty.I have found that most of my patients do very well with the exception of those have large areas of liposuction or lipo-abdominoplasty.  I may use drains on a case by case basis for these patients. A newer option now can include the use of tissue #glue to adhere the abdominal #skin to the #muscle; eliminating any space that previously required a drain.If you go to a plastic #surgeon who uses drains, or if your situation requires drains, they usually stay in 3-5 days but may be required to remain in longer. Your board-certified plastic surgeon will recommend the type best suited for you. The most important decision to be made before performing any surgical procedure is determining whether you are an ideal #candidate.

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

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.

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

Progressive tension sutures use absorbable sutures that close any cavities inside your body that are created after tissue removal, minimizing the risk of seroma/hematoma and making drains unnecessary. It can reduce the risk of infection and your recovery tends to be faster than if drains were used. However, thinner patients may require drains. That's why you have to get a consultation to see which technique would be best for you.

With the use of drains, I have not had the unfortunate experience of a chronic seroma after a tummy tuck.  Find
a plastic surgeon who performs hundreds of tummy tucks each year, has great reviews, and has great before and after
pictures.Kenneth Hughes, MDLos Angeles, CA