I'm wondering if I should into other doctors who perform drainless tummy tucks, patients with drainless seem to be up and around and feel great so much sooner. I would love to be able to stand and move around sooner because I have two babies! My doctor says a minimum of 10 days with drains. My surgery is a little over a month and I've put $1000 down but I'm willing to switch based on these answers. Thank you!
February 7, 2019
Answer: Drainless Tummy Tucks. Why Do So Many Doctors Use Drains? Unless you suture the abdominal flap back down, you have to use drains to absorb the fluid that collects. The fluid will prevent the surfaces from sticking and healing and may form a cavity called a bursa that may require surgery to correct. However drains do not prevent all fluid collection, called seromas, and then the surgeon has to puncture the fluid collection (aspirate the fluid), 1-3 times on average, until no more fluid keeps accumulating. By carefully suturing the abdominal flap back down to the abdominal wall, fluid collection is kept to such a minimum that no seroma can form. Why more surgeons do not use them may be multifactorial, e.g. feeling there is some risk of seroma, thinking that their current technique works for them, so why change? Not wanting to take the extra time, or not wanting to have the added expense involved in taking more time. I have used a drainless tummy tuck for the last five years, and have not had a clinically significant seroma, so this is my method of choice. I originally started with the suturing technique and drains, but there was insufficient fluid in the drain to justify using them, so I evolved to using the suturing technique without drains. The literature supports this: 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.
Helpful 2 people found this helpful
February 7, 2019
Answer: Drainless Tummy Tucks. Why Do So Many Doctors Use Drains? Unless you suture the abdominal flap back down, you have to use drains to absorb the fluid that collects. The fluid will prevent the surfaces from sticking and healing and may form a cavity called a bursa that may require surgery to correct. However drains do not prevent all fluid collection, called seromas, and then the surgeon has to puncture the fluid collection (aspirate the fluid), 1-3 times on average, until no more fluid keeps accumulating. By carefully suturing the abdominal flap back down to the abdominal wall, fluid collection is kept to such a minimum that no seroma can form. Why more surgeons do not use them may be multifactorial, e.g. feeling there is some risk of seroma, thinking that their current technique works for them, so why change? Not wanting to take the extra time, or not wanting to have the added expense involved in taking more time. I have used a drainless tummy tuck for the last five years, and have not had a clinically significant seroma, so this is my method of choice. I originally started with the suturing technique and drains, but there was insufficient fluid in the drain to justify using them, so I evolved to using the suturing technique without drains. The literature supports this: 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.
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February 21, 2018
Answer: Drains vs No drains It is typical for a surgeon to stick with a technique that he/she is comfortable with. While the drainless technique is not new, it has gained some recent popularity due to recent publications. I personally think the drainless technique is superior because it reduces your risk of complications and you can advance the skin further with the progressive stitches. This allows the surgeon to remove more loose skin from your tummy. Hope this helps! Phillip Dauwe, MD
Helpful 5 people found this helpful
February 21, 2018
Answer: Drains vs No drains It is typical for a surgeon to stick with a technique that he/she is comfortable with. While the drainless technique is not new, it has gained some recent popularity due to recent publications. I personally think the drainless technique is superior because it reduces your risk of complications and you can advance the skin further with the progressive stitches. This allows the surgeon to remove more loose skin from your tummy. Hope this helps! Phillip Dauwe, MD
Helpful 5 people found this helpful
December 21, 2017
Answer: Drainless tummy tucks are the way to go The reason many surgeons still use drains after a tummy tuck is because this is the way everyone used to do it. Many surgeons tend to stick to the technique with which they feel most comfortable. However, more and more surgeons are now realizing that tummy tucks can be safely performed WITHOUT drains. And that patients love it! A drainless tummy tuck procedure usually involves placement of multiple "progressive tension sutures" deep under the skin. By helping to quilt down the skin flap to the underlying abdominal wall, this eliminates "dead space" where fluid collections (or seromas) could form. These sutures also prevent shearing forces between the skin and abdominal wall, which reduces inflammation and fluid production under the skin. Both these factors help to make drains unnecessary. These sutures are resorbable and will dissolve over time. Although it takes some additional time to place these sutures, it only adds about 15-30 minutes at most to the procedure time. The additional OR costs for this are not very much - plus drains themselves cost money too. I believe the enhanced patient comfort without drains is well worth this small amount of additional operative time. The other benefit of "progressive tension sutures" is that they help to take tension off the skin closure, and could help prevent scar widening as you heal. There have now been multiple studies with hundreds of patients that had drainless tummy tucks. And these have shown that drainless tummy tucks are indeed very safe - in fact, this technique might result in even fewer seromas than when drains are used. I recommend drainless tummy tucks to tall my patients. Emile N. Brown, MD Johns Hopkins & Harvard Trained Plastic Surgeon
Helpful
December 21, 2017
Answer: Drainless tummy tucks are the way to go The reason many surgeons still use drains after a tummy tuck is because this is the way everyone used to do it. Many surgeons tend to stick to the technique with which they feel most comfortable. However, more and more surgeons are now realizing that tummy tucks can be safely performed WITHOUT drains. And that patients love it! A drainless tummy tuck procedure usually involves placement of multiple "progressive tension sutures" deep under the skin. By helping to quilt down the skin flap to the underlying abdominal wall, this eliminates "dead space" where fluid collections (or seromas) could form. These sutures also prevent shearing forces between the skin and abdominal wall, which reduces inflammation and fluid production under the skin. Both these factors help to make drains unnecessary. These sutures are resorbable and will dissolve over time. Although it takes some additional time to place these sutures, it only adds about 15-30 minutes at most to the procedure time. The additional OR costs for this are not very much - plus drains themselves cost money too. I believe the enhanced patient comfort without drains is well worth this small amount of additional operative time. The other benefit of "progressive tension sutures" is that they help to take tension off the skin closure, and could help prevent scar widening as you heal. There have now been multiple studies with hundreds of patients that had drainless tummy tucks. And these have shown that drainless tummy tucks are indeed very safe - in fact, this technique might result in even fewer seromas than when drains are used. I recommend drainless tummy tucks to tall my patients. Emile N. Brown, MD Johns Hopkins & Harvard Trained Plastic Surgeon
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