Is drainless mini tummy tuck better?

Hello, I previously used drains for all tummy tuck surgery, but after I switched to the drainless technique years ago I rarely use drains. Initially I was reluctant to switch because I was concerned about the internal sutures (called "quilting sutures" or "sequential tension sutures") causing puckering of the overlying skin, or having increased risk of fluid collections (hematoma or seroma). I haven't seen in increase in skin contour irregularities, and although I do get the occasional fluid collection with the drainless technique, this also happened even when I used drains. A drain can't be left in too long or an infection will occur around the drain site on your skin. Once the drain is pulled your body still needs to absorb excess fluid (just like it does with the drainless technique). Although the drainless technique takes longer to perform and therefore is more expensive for the surgeon (because drains are inexpensive and quick to insert compared to doing a sequential tension suture closure), my patients are happy not to deal with the drain maintenance and I haven't seen an increased risk of complications in my practice. Please note this is my personal perspective and other surgeons might find they get good results with drains. I don't know what your surgeon means about the drainless technique changing the space between the muscle, but they would probably be happy to clarify this for you.

Drainless tummy tucks are based on the idea of progressive tension sutures (PTS), which tack the flap down to the muscle. I've been doing PTS for more than 20 years and it does dramatically reduce the amount of fluid that comes out it in the drain. However, the amount isn't zero, and I think it is better to have it come out into a drain rather than accumulate. So drainless isn't necessarily safer.

Dear RealSelfMember09903993,
it is hard to tell for sure without an examination. If you are considering surgery, I would suggest you consult a board-certified plastic surgeon. Only after a thorough examination, you will get more information and recommendations.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

The surgery can be done with or without a drain. That’s something I would leave entirely up to the surgeon and should be the about the last thing to concern yourself with. It’s fine either way and the drain is no big deal at all

Drains are helpful to collect fluids from the surgical area as you heal. They help to prevent seroma formation and are typically only left in for 3-10 days depending on output. Your surgeon will let you know what is recommended for you based on the details of your surgery as well as your medical history.

Drains are used to prevent the build up of tissue fluid and stretching the skin. Many are used as a precaution and do not have to be left long if there is minimal fluid. Let your surgeon, not you, decide if one is needed.

Many years ago when I was a resident I remember being at a conference when one of the speakers said “I’ve never regretted putting in a drain”.
The implied message was of course that all plastic surgeons at one point or another wish they had put in a drain when they didn’t.
Surgical procedures that create large raw tissue surfaces will create a fluid formation during the healing process.
This is classic for a tummy tuck which is the most common procedure to develop a fluid collection after surgery.
The fluid collection is called a seroma.
There are plenty of posts on this website with patients talking about complications related to fluid build ups most of them in relationship to having had some form of tummy tuck.
A tummy tuck typically separates the skin and the fat layer from the underlying muscle fascia. and a full tummy tuck the separation of tissues called undermining is done from the incision all the way to the rib cage. that size tissue separation can generate up to a pint of fluid in 24 hours. Without drains and place the abdomen will soon look like a waterbed mattress.
With fluid separating the two tissue surfaces the space is in capable of staying in contact and will not heal until all the fluid is drained and remains drained.
If left untreated the person will develop a chronic seroma with a scar tissue membrane surrounding the fluid collection.
Once the fluid collection becomes chronic it can no longer be treated by simply draining the fluid.
And mini tummy tuck can be done without undermining. when done in this way the large raw tissue surface potential space is eliminated and a drain is not indicated. The lack of undermining also limits the results to some degree.
Some surgeons attempt to avoid using a drain by various surgical techniques such as putting sutures between the muscle fascia and fat layer or applying surgical sealants.
The most common reason for patients to develop a seroma after plastic surgical procedures as either the failure to place a drain or removing the drain prematurely.
When in doubt surgeons should use drains.Drains reduce the chance of infections and lower complication rates. The biggest drawback to placing a drain is that they are highly annoying and uncomfortable for the patient.
If your surgeon is offering alternatives then you deserve a further discussion and a better understanding about the alternatives imply in regards to results, risks and potential postoperative management.
When postoperative seromas develop the best course of treatment is having the fluid drained using a Cannula or big needle and this should be done as frequently as possible preferably daily until The fluid no longer accumulates. Alternatively a drain can be placed by an interventional radiologist. It’s far easier to simply place a drain during surgery and remove it when it’s clear that it’s no longer needed.
Best,
Mats Hagstrom MD