No Drain Tummy Tuck
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 I have done for my 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. 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. The drains are not only annoying to care for, 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 believe that someday drains in tummy tucks will be a thing of the past as more plastic surgeons realize how much better it is to not have the drains.
Drains and Progressive Tension Suture Tummy tuck: what you need to know
The drainless tummy tuck is based on a technique called Progressive Tension Sutures, which I have been doing for more than 15 years. The original idea was to tack the flap down and reduce the tension on the skin closure, for lower scars. As a secondary effect, this resulted in very low outputs in the drains, enabling them to come out earlier. I have found however that when I remove the fat layer on the flap, which I believe improves the final result, there is still a little bit of fluid so I still use drains but only for 2-4 days. It does not increase anesthesia time by more than a few minutes.
Pros and Cons of Drains in a Tummy Tuck
Thank you for your question and photo. While there are different techniques used by different surgeons, drains should not be the deciding factor in the surgeon you chose. Their training, experience, certifications, and results of many successful surgeries should be the criteria you use. Pain and manipulating your abdominal muscles are the limiting factors on how quickly you are standing, not drains. The "pro" of the drain is preventing a seroma, which can be uncomfortable, cause swelling, can become infected, and leads to more procedures to get rid of it. Other than having to deal with the drains, there aren't any real "cons" to having them for a few days. Drainless tummy tucks take a great deal more time and add cost because of the series of quilting sutures. Preventing easily avoided complication seems like a no brainer. If you trust the Board Certified Plastic Surgeon you've chosen, don't walk away from them based on ideas you got off the internet. Allow her or him to give you the best results they can using the method that has made them successful. Good luck on your procedure.
Drains with tummy tuck
Drains have been used for almost all tummy tucks for the last 50 years. It hasn't been until the last 5 or so years that the progressive-tension suture technique has started to catch on in popularity. For many surgeons that have been operating for awhile and who have very nice results with their tummy tuck procedures using drains, it is understandable that they would be slow to adopt a new technique. Using drains is still preferred by most surgeons and I would not change surgeons just because the one that you have chosen uses drains. In the end, you want to use a surgeon that gets the best results and with whom you feel the most confident.
With that said, I do not use drains and find that patients very much enjoy not having them. My seroma rate is actually lower now than when I was using drains about 3 years ago. I think that the healing process is still quite similar and comparable. But I do think that there is a psychological benefit to not having drains. It makes it seem as if your surgery was not as invasive even though it was the same. And patients are more likely to be up and around quicker because they just feel more normal without the tubes hanging from their bodies.
Drainless TT's are the way to go! Less seromas
I have done thousands of TT's over more than 25 years. I always drained them until 4 years ago when we began progressive tension sutures and no drains. We now have a study with 450 TT's and half are with out drains. The seroma rate with drains was 9 percent and without drains was 2 percent. I do not drain my tummy tucks. I have improved my results and patients are far happier. Less scaring. Less pain. Less seromas. A few minutes of additional time and always less than two hours of surgery.
Pros and cons of using drains in abdominoplasty
It would seem like if you used drains for abdominoplasty you would be able to move around sooner and there would not be any unsightly tubes hanging from the abdomen. Well it would really be your comfort that would allow you to move around. If a proper abdominoplasty was done with rectus muscle and oblique muscle plication that causes a lot of pain with or without drains. It's the pain that will limit mobility and not the presence of drains. The surgeon can use a pain pump which really reduces pain to allow earlier movement and mobility. I don't believe the difference of using drains or not in the long scheme of things really changes the outcome of the abdominoplasty. The technique of using sutures to close the dead space in the abdominoplasty flap does help to eliminate most of the dead space. There still has to be adherence of the tissues completely which takes time. Being very active may still result in seromas under the abdominoplasty skin flaps not to mention tearing sutures for the abdominal muscle repair. The sutures have to be placed perfectly or there can also be traction dimples on the skin flap. Finally there is the additional time, sutures, foreign body and anesthesia that is required to put in the extra sutures. There are other techniques of using tissue glue and not sutures to close the dead space off but again there are extra costs involved. These tissue glues cost between $200 to $350 depending on the amount used. Does a few days of drains really make a big difference. Probably not in the long run. If there was such a noticeable difference then 100% of the doctors would be using this technique and it would then be the standard of care.
Drainless Tummy Tucks are Becoming More Popular with Plastic Surgeons
Drainless tummy tuck is a great procedure in the right patient. However regarding your particular case, I
would need more information and ideally a physical exam before I could give you
sound advice as to what would be best for you. In a properly chosen patient, I feel that the drainless tummy tuck has
many advantages over one done with drains. These would include, as you said, minimal actual down time, because the
tissues are firmly held together and are allowed to heal immediately. This is in contrast to the significant down
time while you have drains in, in order to get the unfastened tissues to heal
to one another. Unfortunately, these
days patients are often more active than they should be, especially in the crucial
healing period (the first 5-7 days), which prevents the tissue from sealing the
space between the fat and underlying muscles. Often, this scenario will result in a seroma, hematoma or even an abscess,
when the drains are removed, which further hinders healing and could even require an additional procedure to
treat a complication.
The other reason why early activity is important, is the prevention of clots
from forming in the in the veins of the legs and pelvis, which can sometimes
pass into the lungs and make the patient quite ill, and in some cases can
actually be fatal.
Some would say that the procedure takes too long if the drainless technique
is used. However, it has been my experience that once one gets through the learning curve, the added time
can be minimal.
Others say that they have had problems with fluid collections that needed
to be drained, however, this has not been my experience, and several studies in the Plastic Surgery literature, done by surgeons who are proficient at
this technique have shown this not necessarily to be the case.
With all of this said, each surgeon chooses the technique that they are
most comfortable with, and thus, I would advise you to pick out a well-qualified
surgeon and have he/she perform the technique that works best for them.
Drainless Tummy Tuck is safe, but not all patients are candidates
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.
Why Some Surgeons Do Not Use TT Drains
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.
Drains and Tummy Tucks
Thank you for your post. Whenever there is a potential space in your body, your body tends to fill that space with serous fluid (the yellow type of fluid that also comes out of a 'weeping wound'. This is similar to when you get a blister: the layers of skin separate and fluid is deposited in to the space. In a tummy tuck, the space is in between the skin/fat layer and the muscle layer. Most surgeons will place a drain to remove this fluid while your body is secreting it until the fat layer grows back together with the muscle layer. At that point, no more fluid is secreted into the area, because there is no more space for fluid. The length of time that this takes varies from patient to patient. Some patients heal much faster, thus the layers seal together much faster. Also, the more twisting motion you have in your belly area, the slower the two layers grow back together because they are moving in relation to each other. The fluid coming through the drain can be initially dark red, and eventually clears to pink then yellow. This is because it takes just a little bit of blood to make the fluid dark red. Also, initially, there can be a large amount of fluid (few hundred cc's in the first day is not out of the range of normal) and this should slow down substantially over next few days. Once the fluid slows down to the amount that your surgeon is comfortable with (usually 25-50 cc in 24 hours) then they will be pulled. There is minimal discomfort in pulling the drain in most patients.
More recently, 'drain free' surgery has become more popular. Fat layer is sutured down to the muscle layer starting at the ribs and progressively down to the lower incision. This makes the space for the fluid to collect much smaller, and in many patients can have surgery without drains. However, I have seen multiple patients come from other surgeons because they developed a seroma despite the suturing of the tissue. This is not the surgeon's fault, but some patients just do not heal fast enough or put out too much fluid for the body to absorb.
Pablo Prichard, MD