Drainless tummy tuck concerns. Why don't more surgeons use this technique?

   I would assess tummy tuck results by before and after pictures and reviews.Kenneth Hughes, MDLos Angeles, CA

There
are multiple techniques for tummy tuck. Traditionally this operation is
performed with drains. The skin is elevated off of the abdominal wall,
the excess is excised, and the skin is draped over the abdomen. This
leaves a large area that needs to heal by sticking back down to the abdominal
wall. Drains provide a way for the fluid and blood to be evacuated and
speed the process of the abdominal skin sticking back to the abdominal wall.
If drains are not used, the fluid that is generated by the elevation of
the skin is still generated. Those of us that use drains do not believe
that simply by quilting the skin to the abdominal wall will prevent the
accumulation of fluid. In fact, the quilting would make the fluid
accumulate in isolated pockets. Drains are a very useful tool in an
abdominoplasty. They are temporary. If they affect the outcome in
a negative way, were difficult to manage after surgery, or were permanent, then
it would be a topic worth debating. There are surgeons that have good outcomes
with drains, and surgeons that have good outcomes without drains. Pick
your surgeon based on their outcomes, professionalism, experience, training,
ability, not on whether they use drains.

The purpose of applying #drains to a tummy tuck is to release extra fluid that may otherwise accumulate under the skin, fat or muscle following surgery. 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. Also, a newer option now can include the use of tissue #glue to adhere the a#bdominal #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. The most important decision to be made before performing any surgical procedure is determining whether you are an ideal #candidate. Your board-certified plastic surgeon will recommend the type best suited for you during a one-on-one in-person consultation. Also, another element to a satisfying result of your procedures are realistic #expectations.

A drain-less tummy tuck is not fool proof (nothing is), it takes a bit more time under anesthesia to place these stitches and a girdle is generally worn immediately but it does 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.#tummytuck#TT

Thank you for your question. Some surgeons utilize drains and some do not. A drain maybe placed to help reduce the risk of seroma formation. I would not recommend you use drain placement be the deciding factor in choosing your PS. A nice result can be achieved either way. I do the procedure both ways. Best of luck.

Most plastic surgeons would agree that you can have a nice abdominoplasty result with or without using drains and that this should be a low priority when choosing a surgeon.  An abdominoplasty that has lots of undermining (think flipping the sheets on a bed) creates a lot of open space for fluid to accumulate.  I use quilting sutures to help close down the space and to take tension off of the wound, but still use a drain.  The drain comes out earlier and you get the best of both worlds.  Techniques which minimize undermining tend to have higher placed scars which I try to avoid if possible.

Some excellent plastic surgeons use drains, some use internal
quilting sutures, and some use both. Whether a surgeon uses drains or not
should be one of the least important factors in choosing the surgeon. The
choice of drains or no drains should depend on the extent of the procedure and
the surgeon’s opinion based on his or her experience. Good results have been
obtained both with and without drains. The length of the recovery and the
extent of swelling are not diminished in procedures where no drains are used.

What is far more important, is the choice of the
surgeon. I would suggest you find a plastic surgeon certified by the American
Board of Plastic Surgery and ideally a member of the American Society for
Aesthetic Plastic Surgery (ASAPS) that you trust and are comfortable with. You
should discuss your concerns with that surgeon in person. While a second or
third opinion may be worthwhile, continuing to pursue consultations until you
get the answers that you think that you want to hear may not necessarily be in
your best interest. If you are ambivalent, don’t do the procedure.

Robert Singer, MD FACS

La Jolla, California

Quilting and progressive tension sutures have been a great addition to the technique of abdominoplasty. When performing an abdominoplasty, the skin and fat is lifted off the abdominal muscles to allow suturing of the muscles and to mobilize the skin flap so it can be pulled down and tightened. In the past, we sutured the skin together and relied on drains to evacuate the fluid between the skin flap and muscles. Quilting and progressive tension sutures between the skin flap and muscles allow us to distribute the tension throughout the flap so the tension at the skin suture line is less than with older techniques. The skin can actually be stretched tighter but with less tension at the suture line. Securing the flap this way allows for less motion between the flap and muscles and faster healing of this layer. It greatly reduces the need for drains. I still think it is wise to use a small drain for a few days to eliminate any excess fluid. If no drains are used, a number of patients (about 10% in my estimation) will develop a fluid collection (seroma) between the skin flap and muscles. This may require repeated needle aspiration and if it becomes infected, the whole incision may need to be opened. In my opinion, using the combination of quilting and progressive tension sutures and small drain for a few days is much safer than the "no drain" technique.

I agree that great results from a tummy tuck can be achieved with or without the use of drains.  I love the drainless technique where internal quilting sutures are used.  In my experience, I feel I can remove more skin than with the "standard" technique, not less.  But this is purely a subjective assessment.  The main disadvantage with the drainless technique is that is adds 30 to 45 minutes to the length of surgery, compared to the other technique.As with all surgeries, it is important to find the right surgeon for you.  If they produce reliably good results, the technique is much less important.  Hope this helps.