Drainless tummy tuck without progressive tension sutures?

I met with a board certified plastic surgeon who explained to me that you don't need progressive tension sutures for a drainless tummy tuck. He said that limited undermining of the upper abdominal skin protected the blood and lymph system so drains weren't necessary. His patients seem very happy with their recovery and results. I'd like to avoid drains but I'm nervous because no one else seems to do it this way. Why isn't this technique more popular?

Doctor Answers 11

Options for Reducing Tummy Tuck Seromas

Thank you very much for your question...its a good one.  The exact cause of fluid collection or seroma after a tummy tuck is not completely understood.  Probable causes include disruption of the lymphatics during surgical dissection, the inflammatory response to injury, or heat associated with electrocautery.  Drains are the most commonly used technique to reduce the risk of a seroma, but they are not full proof.  Patients and surgeons have been trying many different techniques over time to avoid their use due to the discomfort and fear caused by drains.  Other techniques include  using fibrin sealant, a new tissue glue just approved, progressive tension sutures, compression, limiting dissection, preserving some of the fascia called Scapa's, external compression, and vacuum dressings.  UEach of these strategies has some merit, but the scientific literature does not show that one approach is clearly superior to the others.  Until the research is clear, most doctors stick to the standard of care which is using drains.  All of these strategies are appropriate and combining several may be of benefit.  None has shown clear superiority over others.  Best wishes.

Drainless tummy tuck

Thanks for your question. The studies using the no drain technique still show a 10% seroma formation rate. Although an attractive option, I perform the sequential progressive tension sutures as well as drains. I have a 0% seroma rate with this technique. In my opinion, patients with very little fat can sometimes be done without drains but I don’t take the risk.

Hope this helps,



The technique that your doctor is talking about is called Lipo-Abdominoplasty.  It is generally used in obese patients as analternative to the traditional tummy tuck, since
this group of patients tends to have a relatively high complication rate.  Because there is much less undermining of the abdominal soft tissues, there is much more preservation of the lymphatics,
blood and nerve supply to the abdominal flap, and this helps minimize serious complications
such as seromas, wound healing problems, infections and tissue necrosis.  The downside of the technique is that very little if any muscle plication is performed.  Thus patients that have
protuberant abdomens due to rectus diastasis or increased intra-abdominal
volume caused by previous pregnancy or visceral fat accumulation are not great
candidates for this procedure.  They should be counselled regarding realistic
expectations with regard to protuberance of the abdominal wall. 

Additionally, no technique of abdominoplasty is associated with zero dead space.   Thus some type of inner sutures will be needed to close the areas of dead space in order to prevent seromas.  The alternative would be placing a drain or two in the dead space. 

Thus, if you don’t have a high BMI and have significant
abdominal protuberance, you can probably get a better result with the
traditional tummy tuck which allows your surgeon to adequately plicate the fascia
of the abdominal wall and give you your six pack back.

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Drain-less Tummy Tuck

Plastic surgeon performing tummy tucks for more than half a century years have used drains. Recently a technique has been slowly becoming more popular using Progressive Tension Sutures (quilting stitches) to attach the superficial skin/fat to the deep muscle layer below to prevent fluid accumulation that a drain would otherwise remove. It is not fool proof (nothing is), takes a bit more time under anesthesia to place these stitches and a girdle is generally worn immediately but a drain-less Tummy Tuck seems to work well. Patients tend to like this as there is no drain care and they can shower earlier. There is more chance of a seroma if tension sutures or drains are not used.  Even with these sutures 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.

For those patients who choose another surgeon, the question to drain or not to drain is at the surgeon's discretion. There is no consensus at this point though most surgeons still favor drains until the output is generally about 30cc/24 hours. I individualize and if little or no liposuction at the time of a tummy tuck, a minimal or mini-tummy tuck I often do not use drains, whereas for significant liposuction with a tummy tuck and other procedures (#MommyMakeover) I most often use drains but individualize as needed.


Tummy tuck techniques vary by surgeon

Hello. Tummy Tuck techniques do vary by surgeon, and the use of progressive tension sutures and drains is an example of this.  The drains are a little scary, but getting a fluid collection, called a seroma, after surgery can be a problem. I would follow the advice of your plastic surgeon, since she has happy patients. And if she likes to use drains, then there is a good reason. Good luck.

Anne Taylor, MD
Columbus Plastic Surgeon
5.0 out of 5 stars 33 reviews

Drainless tummy tuck without progressive tension sutures?

Thank you for the question. It is extremely common to receive different opinions from different plastic surgeons about the best way to treat a specific “problem”. Each plastic surgeon may have his/her opinion that is based on their specific/unique education, experience, and personal preferences. Their opinions may also be shaped by unfavorable results they have encountered in their practices.
Although these different opinions can be confusing and a source of anxiety for patients, it is good for patients to understand the different options available. Ultimately, it will be up to each patient to do their due diligence and select their plastic surgeon carefully. Part of this selection process will involve the patients becoming comfortable with the plastic surgeon's experience level and abilities to achieve their goals as safely and complication free as possible. In my practice, I currently use drains for all tummy tuck patients; I also use progressive tension sutures for most patients.
I hope this, and the attached link (dedicated to tummy tuck surgery concerns), helps.

Drainless tummy tuck without progressive tension sutures?

Dear tummytuck127

I think you should look at the issue this way: If most plastic surgeons use drains, and then you have a few that don't, and if most results with drains are excellent, why do you want to be part of the people that are doing something still in question???? (I'm by no means saying the outcome is worse)
At this point, we know that using drains has great results with little risk and minimal pain/discomfort. We also know that you can get away without using drains with quilting techniques or if the dissection is done perfectly by a very gifted surgeon. I would go with the technique that is consistent and proven with low complications. Which is why most surgeons use drains! When there is enough data, most surgeons will switch if data supports no drains.
When it comes to phones, buy the newest technology, it might cost money to replace a bad one. With surgery, do you want to go with the newest technique??? whats the value of lower likelihood of having a seroma??
Focus on finding an experienced surgeon that produces consistent and reliable results, (irrespective of drains or no drains) best of luck!!

Afshin Parhiscar, MD
Bay Area Plastic Surgeon
4.9 out of 5 stars 48 reviews

No drain tummy tuck

The anatomy of the abdomen has the existing internal lymphatic drainage. Preservation of this with specific surgical technique facilitates drainless tummy tuck without progressive sutures.
Check with your board certified plastic surgeon to see what technique he or she uses.
Please view the video link provided which I had made for my talk at ASAPS on drainless tummy tuck.

Drainless tummy tuck without progressive tension sutures?

Your surgeon is correct. If done properly, this technique can avoid drains and progressive tension sutures. See the link below for our recent medical publication on this very topic.

Karol A. Gutowski, MD, FACS
Chicago Plastic Surgeon
4.9 out of 5 stars 63 reviews

Drainless tummy tuck without progressive tension sutures?

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

Robert Singer, MD
La Jolla Plastic Surgeon
4.6 out of 5 stars 19 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.