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 21

Drains Vs No Drains

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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 27 reviews

Drains with Tummy Tuck

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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

Do I need drains when I have a tummy tuck?

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I have had really good success with using tissue glue for closure of the tummy tuck/abdominoplasty without the use of drains which are quite a hassle for patients. Finally, one has become available that is synthetic and not from human products so there is no need to worry about problems like before. I am very pleased with my results with this new product as are my patients, especially the ones that come to see me from different parts of the country and overseas! I have even started using it in my post-bariatric plastic surgery patients. 

Dr. Edward Jonas Domanskis is Certified by the American Board of Plastic Surgery 

Newport Beach, San Francisco,Miami, Italy, Anguilla 

949.640-6324/1.888.234-5080(Ca) FAX- 949.640-7347 

Assistant Clinical Professor of SurgeryWOS-Plastic,University of California (Irvine)

Orange County’s Physician of Excellence/America’s Top Physicians/Top Doctors Plastic Surgery- 2005-2017 

President,American Society of Bariatric Plastic Surgeons

Edward J. Domanskis, MD
Newport Beach Plastic Surgeon
4.5 out of 5 stars 28 reviews

Drains vs. No drains with Tummy Tuck

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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.

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

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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

Do you need drains after tummy tuck?

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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.

Drain Free Tummy Tuck with TissueGlu

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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.

John L. Burns Jr., MD
Dallas Plastic Surgeon
4.7 out of 5 stars 59 reviews

Drains vs. No Drains with a Tummy Tuck

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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.

Jed H. Horowitz, MD, FACS
Orange County Plastic Surgeon
4.9 out of 5 stars 116 reviews

About No Drain Tummy Tucks

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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




Dhaval M. Patel, MD
Hoffman Estates Plastic Surgeon
4.8 out of 5 stars 100 reviews

Drains or No Drains TT

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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 18 reviews

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.