My Doctor Does Not Use Compression Garments After a Tummy Tuck is This Safe/ok?

Question

My plastic surgeon does not place his patients in any type of compression garment after performing a tummy tuck on them. He says there is no scientific facts to support that these items help or aid in better results or healing. But believes they cause unneccessary pain and discomfort and actually increase swelling in the lower limbs and restrict blood flow. Is this safe or ok to do and will this have a negative effect on my results?

Armando Soto, MD, FACS · Answer

Hi there-

	As you can read, you will find many differing opinions on this matter- it reminds me of something my chairman of surgery used to say during my training- "When data is poor, emotions will run high"...

	He meant that when proof of one opinion or another being absolutely correct is lacking, proponents of differing opinions will argue passionately for their point of view.

	I know from experience that it is safe and effective to perform tummy tuck (abdominoplasty) surgery with or without compression garments. There is no doubt that if you are dealing with a compliant, intelligent patient who will be good about following all postoperative instructions, that the binder may not be absolutely necessary. 

	On the other hand, let's apply some common sense here... The critical intervention performed in a tummy tuck is the repair of the diastasis recti (the separation of the abdominal muscles that results from the stretching force of the growing uterus in pregnancy). By applying gentle compression using a garment, these important sutures are taken off of tension to some degree, supporting their healing, reducing pain, and reminding the patient of the importance of not straining these muscles. Without this gentle compression, it is hard to imagine that these sutures would not undergo at least a little stretching and pulling after surgery- resulting in a more pain and a diminished result.

	While the arguments against their use can also sound compelling (pressure from the garment reducing blood flow to the skin and making it more difficult for blood to return to the heart from the legs, increasing the risk of blood clots), I think the reality is that if the blood supply to the abdominal skin is so tenuous as to be compromised by a garment that surgeon's technique is probably too aggressive.

	Similarly, while blood clots are a serious risk that we should all take very seriously, there are many, more important risk factors for blood clot formation, and many, more effective precautions that can be employed to prevent them than the avoidance of a garment. In other words, if a patient gets a blood clot after a tummy tuck, the likelihood is that the greatest factors in its causation were unrelated to use of a binder (length of surgery, lack of attention to appropriate precautions before, during, and after surgery).

	I think that as long as appropriate attention is paid to the precautions that I know are important in the prevention of blood clots, and as long as I use safe surgical technique in the performance of my tummy tucks, that the benefit to my patients of using a compression garment are undeniable. Indeed, most of my patients ask to be allowed to continue to use their garment even after I tell them they are free to go without it!

	Having said all of that, it is really important in general that you follow the recommendations and precautions that your chosen surgeon has found to maximize the success of his patients in the past. It would not be fair to him to engage him to do your surgery, only to alter his postoperative plan for you based on what we say on this site. If you are concerned about the recommendations you are getting from him, discuss it further, in an open and honest fashion. Be comfortable with the choices you make.

Lewis Albert Andres, MD · Answer

Hello!  Thank you for your question!.  The tummy tuck procedure is an 
excellent method for contouring of your abdomen, often removing the 
excess skin as well as tightening the abdominal wall.  After nearly all 
surgical procedures, a potential space is created from where the 
surgical procedure/dissection was performed.  This is especially true 
for the tummy tuck, in where the abdominal flap is raised off of the 
abdominal wall and then redraped atop the area to contour the abdomen.  
The procedure alone promotes swelling and inflammation, which typically 
lasts for 6-12 weeks.  This may even last longer if liposuction has been
 performed in addition.  During this time, a few things may be done to 
allow adherence of the abdominal skin/soft tissue to readhere to the 
abdominal wall and close that space.  Many surgeons use drains to 
evacuate the expected serous fluid from building up.  Stagnant fluid as 
such may be a nidus for infection as well as does not allow the tissue 
to adhere back to its normal anatomic position.  Drains usually are 
removed once output is <30cc/day - usually removed within 3-4 weeks 
on average, sometimes longer.  When this occurs, a seroma may develop - 
which may require aspiration or surgical evacuation to rid this in order
 to optimize your result.  This is not an uncommon reason for 
persistent swelling and/or bulging in a certain area of your belly.  Of 
course, thwarting the development of a pseudobursa, or seroma capsule, 
is always best, to provide the best result as well as avoid any future 
procedures for this.  This may be a troubling consequence and often 
compromises your overall result.  Thus avoiding this complication, in 
whatever manner, is the objective.  "Drainless" tummy tucks are becoming
 more popular - basically, the overlying tissue is physically sutured to
 the abdominal wall to close the potential space.  In addition, most 
surgeons typically restrict vigorous activity/strenuous exercise as well
 as lifting restrictions of usually <20#, especially the core, for 
6-8 weeks to allow healing to continue.  Most also often recommend an 
abdominal compression-type binder or garment, which will serve to 
provide 
compression as well as assist to decrease swelling and eliminate the 
dead-space of the area for at least 6 weeks as well.  After the initial 
binder, many patients like the Spanx garments.   Most patients are 
able to return to most activities within a couple of weeks, provided 
they adhere to the restrictions.  Overall, this is a procedure 
with a high satisfaction rate.  Discuss the procedure and postoperative 
instructions/restrictions with your surgeon, as these will vary among 
surgeons. Not all use a garment afterwards.   Hope that this helps!  Best wishes!

Richard H. Tholen, MD, FACS · Answer

Though the majority of plastic surgeons use abdominal binders or compression garments after tummy tucks, I am not aware of a randomized study comparing results, complications, and patient comfort between binder and no-binder groups. Obviously, there are surgeons who prefer to use scientific evidence rather than "established practice," habit, or how their professor trained them as basis for these types of decisions. Often, progress is made in surgical practice because someone decided to challenge the "normal" and go against the "conventional wisdom!"

	I appreciate Dr. Aldea's insight and personal experience with no binder use in his own patients.

	I also must say that Dr. Harrison's answer was the same I received when I asked my own office staff about their own tummy tucks. I've also had patients ask if they can re-use their binder (after the immediate post-op use has been discontinued) because they say they feel more comfortable with it on when pre-menstrual, swollen, or after eating salty foods, for example. They actually prefer the "extra" support, and "miss it" when it's discontinued!

	As a surgeon who has had 4 abdominal operations myself, I can also identify with the fact that when I sneezed or coughed after surgery, external support (either by abdominal elastic binder or simply splinting my abdomen with my arms) made the tender incisions and muscle repair feel less uncomfortable and better protected. Seroma formation may be decreased with compression, but there are also tummy tuck surgeons who advocate no use of drains and seem to avoid seromas in the majority of their patients.

	But, ultimately, you chose your surgeon on the basis of many factors, and you should follow your own surgeon's advice. I like the fact that he's basing his advice on lack of science that "proves it's necessity" rather than "the conventional wisdom." But then again, there is a reason that the majority of surgeons use some sort of properly-fitted, non-binding, non-constricting, and non-blood clot-inducing compression. Not necessarily because it's proven beyond scientific reproach to be of benefit, but sometimes just because it's more comforting for the patient! And there's nothing wrong with that at all!

	It certainly seems as if this would make an interesting study.

	Best wishes!

Vishnu Rumalla, MD · Answer

Thanks for your question. Every surgeon has a routine which should reliably and reproducibly obtain a good result. That being said, if you like the results your surgeon gets, then you should follow his/her advice. I always use a binder after tummy tuck and girdles after liposuction. I think they reduce pain, provide support, help contour, and reduce swelling. The garments are supposed to be snug, not tight or constrictive. I see patients often during their recovery and adjust and change their garments accordingly. Good luck.

J. Jason Wendel, MD, FACS · Answer

Thank you for your question. On the contrary, an abdominal binder can provide comfort and support after tummy tuck. Most plastic surgeons use them but some don't. If you go forward with surgery, follow your surgeon's instructions, not the advice of others.

Ronald Schuster, MD · Answer

Listen to your surgeon. I don't put anyone in a girdle till 1 week after surgery. I do use an abdominal binder for the first week. This helps to give support but can be adjusted so it is not too tight.

Peter A. Aldea, MD · Answer

I completely agree with your surgeon. There is no scientific evidence that the use of binders and compression garments speeds healing in any way. There is however anecdotal evidence that they may be associated with a greater rate of blood clot (DVT) formation, higher incidence of fevers and pneumonias and decreased blood flw to the areas of tummy skin just above the mid-tummy scar which may proceed to death with wound separation. 

	But doctors are creatures of habit. We often do things we think work base we have done so for a long time. But Medicine can only advance if we are willing to make changes based on science and proof. Just think where medicine was just 150 years ago - leaches, cupping, lack of sterility and more. 

	Following the path of those who trained me, I used binders and compression garments for years. After considering the science , the greater comfort of NOT aving something push against a freshly operated tummy making breathing and sitting harder, I stopped using them and my patients save money and are happier. 

	Every surgeon must do what he thinks would be in his patients' best interest.

Craig Harrison, MD · Answer

As a habit I use a abdominal binder post op tummy tuck for patient comfort. I recently attended a Plastic Surgery meeting in Chicago and was told by many plastics surgeons there that they had abandoned use of garments post op for tummy tucks and liposuction. When I mentionned this "trend" my office staff, who all have recovered from various procedures, they just laughed and said, "that is spoken by a surgeon who has never had surgery himself". Your best bet is to follow your surgeon's advise. Dance with the one who brung you.

Peter E. Johnson, MD · Answer

We do not know of a surgeon who does not use an abdominal binder after tummy tuck, and there is evidence that the binder will provide support to the muscle repair, reduce pain, reduce swelling, and reduce seroma formation. Those who swim against the tide might become better swimmers, though more often, they drown. If he won't give you a binder you can get your own. You can also get a second opinion.
	Best of luck, peterejohnsonmd.com

Tom J. Pousti, MD · Answer

Thank you for the question.

	Assuming you have done your due diligence and selected your plastic surgeon based on appropriate training, experience,  and ability to produce the results that you are looking for, you should listen to his recommendations. Having trust in your plastic surgeon is important;  otherwise, you will be second-guessing every recommendation made. 

	Best wishes  for a safe procedure and an uneventful recovery.

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