Mommy makeover - Drains vs. no drains? Advantage or disadvantages?

Question

I am a 52 year-old woman, and I am scheduled for a mommy makeover in March. When I was interviewing surgeons, I discovered that some use drains and some do not. I'm not looking forward to having drains, and I'm wondering why some surgeons don't use them. What are the advantages/disadvantages of using them, are there greater risks one way or the other, and should I reconsider my surgeon if he uses drains? Thank you in advance for your response!

J. Timothy Katzen, MD, FACS · Answer

Hi AshleyL311, in Frisco, TX, thank you for your question regarding a mommy makeover, drains versus no drains, and the advantages and disadvantages.  A mommy makeover commonly combines procedures such as abdominoplasty, liposuction, and breast surgery.  The discussion about drains primarily applies to the tummy tuck portion of the operation, where fluid accumulation can occur after elevation of the abdominal flap.  Surgical drains are designed to remove blood and lymphatic fluid thatcollectst in the dead space created during tissue dissection. By evacuating this fluid, drains can reduce the likelihood of seroma formation and decrease pressure on the incision line.  In certain higher-risk patients, such as those with a history of massive weight loss, elevated body mass index, extensive liposuction, or prior abdominal surgery, the amount of dead space may be significant, making drains a reasonable precaution. Many surgeons continue to use drains because they were trained with them and find the system predictable and reliable in managing post-operative fluid.  Despite these advantages, drains are not without drawbacks.  Patients often find them uncomfortable and cumbersome. They may restrict movement during the early recovery period and require daily measurement and care.  Although the risk of infection sisslow, a drain creates a temporary pathway between the surgical site and the external environment.  In addition, many patients report that managing drain bulbs adds psychological stress during recovery.
A no-drain tummy tuck relies on progressive tension sutures, also known as quilting sutures.  These internal sutures anchor the elevated abdominal flap to the underlying fascia, thereby eliminating dead space and distributing tensionovers alargerr surface area.  By securing the tissue internally, shear forces are minimized, and fluid accumulation is significantly reduced. When performed meticulously, this technique can achieve seroma rates comparable to or lower than those seen with traditional drain-based approaches. The primary advantages of the no-drain technique are improved patient comfort and earlier mobility, since there are no external tubes to manage.  The risk of infection associated with an external device is eliminated, and tension along the incision may be better controlled by internal flap fixation.  However, this method does require additional operative time and technical precision.  If quilting sutures are not placed properly, the risk of seroma may increase.
 Furthermore, in patients with very thick abdominal flaps, substantial tissue redundancy after massive weight loss, or extensive upper-abdominal liposuction, drains may still provide an added margin of safety.  Current evidence suggests that outcomes depend less on the presence or absence of drains and more on the effectiveness with which dead space is managed.  The extent of dissection, patient-specific risk factors, and surgical technique ultimately determine complication rates. Drains are not obsolete, nor is the no-drain approach universally superior. Each method has a role, and the appropriate choice should be guided by anatomy, operative plan, and the plastic surgeon’s experience.  The central issue is not whether drains are used, but whether dead space is adequately controlled.  When dead space is minimized and tissue is securely anchored, drains may be unnecessary. If dead space is significant, drains may serve as an additional safeguard.  Good luck.  I hope that i have answered you question regarding a mommy makeover, drains versus no drains, and the advantages and disadvantages.  If you have any further questions regarding tummy tucks, abdominoplasties, or abdominal liposuction, consult an experienced plastic surgeon. Since tummy tuck surgery is a major procedure, please seek an experienced, board-certified plastic surgeon with significant experience performing tummy tucks.  Do your research.   If you cannot find an experienced tummy tuck plastic surgeon in your neighborhood, consider traveling out of state.  Sincerely, Dr. Katzen, MD, MBA, FACS, FICS. ( Plastic Surgeon, President of the American Society of Bariatric Plastic Surgeons, certified by the American Board of Plastic Surgery, Fellow of the International Society of Aesthetic Plastic Surgery, American College of Surgery, and International College of Surgery and ​member of the American Society of Plastic Surgery, American Academy of Cosmetic Surgery, RealSelf Hall of Fame, and RealSelf Doctor Advisory Board for Medical Review and Consumer Panel.)

Sedat Tatar, MD, FACS, FEBOPRAS · Answer

Hello, I’m Dr. Sedat Tatar, a double board-certified plastic surgeon from Istanbul.
In Mommy Makeover surgery, both drains and no-drain techniques can be appropriate when used correctly. Drains help reduce fluid accumulation (seroma) by removing excess fluid during the early healing phase, which is why I prefer using them, especially in combined procedures. No-drain techniques rely on internal sutures to limit dead space and may improve comfort, but they can still carry a risk of fluid buildup in certain patients.
In summary: drains may slightly affect early comfort but can play an important role in lowering seroma risk, particularly after extensive surgery.

Jacob Carlson, MD · Answer

I tell my patients that drains are annoying, but they serve a purpose. For my mommy makeover procedures, I leave drains in the abdomen. Depending on what your surgeon is doing for the breasts, they may decide to leave drains there as well, but I've personally not found much use for drains in the breasts for the vast majority of the breast portion of mommy makeovers.
The main purpose of drains in a mommy makeover procedure is to remove the fluid that would otherwise build up underneath the skin. The don't prevent bleeding, but having drains present can help your surgeon determine if there is ongoing bleeding after surgery.
Assuming that you surgeon is doing an abdominoplasty, they are going to separate the skin and fatty tissue of the abdomen from the muscles. They will also create a tunnel in the same space leading all the way up to the bottom of the sternum. After they cut off the tissue for the tummy tuck and close it, that space that is created during the surgery will begin to fill up with fluid. Doing liposuction at the same time will increase the amount of fluid that builds up even more. Even if you wear compression garments and get lymphatic massages, the amount of fluid that builds up is often much more than your body is able to absorb quickly. If that happens you develop a fluid collection called a seroma. If a seroma is small, your body will eventually reabsorb it. But if the seroma is larger, then it will need to be drained by some means (e.g. aspiration or drain placement). If the fluid sits there for a prolonged period of time, then (in addition to having the swelling for a long time) a capsule can begin to form around the fluid. If a capsule forms, then the odds of being able to successfully drain the fluid collection with either aspiration or drain placement decreases significantly. In most of those cases, patients will need an additional procedure to remove the capsule to prevent fluid from building up there in the future.
There unfortunately aren't a lot of good alternatives to drains. I mentioned compression garments and lymphatic massages earlier. Even if you are diligent with those, it's hard to 'get ahead' of fluid that is continuously collecting in the space that is created during surgery. I've seen some surgeons try quilting sutures to reduce the space where fluid can build up. The challenges I've seen with that option are: it's more time consuming, it's not always effective, and some patients complain of additional pain because the quilting sutures dig into the muscles of the abdominal wall.
Obviously deciding who is going to perform your surgeon is a very important and personal decision. My personal recommendation would be to use a surgeon with whom you feel most comfortable. Ask your surgeon what their protocol for drain removal is - are drains removed at a certain day after surgery? Do they wait until the drain output is below a certain amount? If you decide to go with a surgeon who doesn't use drains, I would ask them what their protocol for managing seromas is.

Steven H. Wiener, MD · Answer

Thank you for your question. The answer is really up to your surgeon.  No drains tummy tuck is a marketing ploy.  You should not choose your surgeon based on the use of drains or no drains.  Interview several surgeons, review their pre-operative and post-operative photos.  Determine how long they have been in practice, how many procedures have they done?  Where will the surgery take place, what type of anesthesia is used.  These are the important questions to ask, drains vs. no drains is by surgeon preference, and do not use that as a criteria to choose your surgeon.

Julia Spears, MD · Answer

Hello! Thank you for your question!
Some surgeons use drains during a mommy makeover (abdominoplasty) to remove excess fluid and reduce the risk of complications like seroma and delayed healing. Other surgeons may avoid drains by using specialized internal suturing techniques that close the space where fluid would collect. 
However, this is not appropriate for every patient or every procedure.
Using drains means a surgeon is more cautious. In many cases, they are the safest way to protect your results. The best approach is individualized, so it’s important to ask your surgeon why drains are recommended for you.

Michael Baumholtz, MD, FACS · Answer

Thank you for your question. 
the best answer anyone can give you is this -
assuming you are scheduled for surgery with a board certified plastic surgeon
1) ask your surgeon why and how drains are used.
If youre satisfied with your answer and you otherwise liked the surgeon (you mentioned you were already on the schedule for surgery) - then go with whatever technique that surgeon favors. typically there's a reason we tend to favor one way vs another (and the answer is usually related to what works best in our hands).

2) as an aside - I've never met a case where I was unhappy I used drains - but I've seen enough where I wish drains were used (my cases or others).

Hope that helps and wish you well!

Dr B

Camille Cash, MD · Answer

I prefer to use drains with tummy tucks in most cases.  Drains, while understandably no one's favorite part of the surgery, are helpful.  They collect fluid as the body heals.  They help to prevent seroma formation and infection.  They are in for a short period of time at the initial part of recovery when you aren't very active any way.  In short, they are a great tool to keep complication risks low and get you to the optimal outcome from your surgery.

Mommy makeover - Drains vs. no drains? Advantage or disadvantages?

Answers (7)

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