Drainless tummy tuck... Are there extra risks?

Question

I got visited a doctoe and got a quote on a tummy tuck procedure last year. I've contacted the office again to talk about scheduling but have to wait 8 weeks for a visit. I just now discovered the "drainless" tummy tuck on this site. The draining was always the part about recovery that I feared and dreaded. Can someone tell me what the additional risks are if any and if it would likely be more expensive Been budgeting for the standard procedure. MS - North Jersey

Rodney A. Green, MD · Answer

I have been using the drainless approach to Tummy Tuck surgery. I use the technique which sutures the skin flap down to the muscle with multiple stitches. I think that there are many advantages and that this helps reduce the tension on the scar. There is always a risk of fluid collection under the skin flap after a tummy tuck, but if anything the risk is lower using the technique of stitching down the skin flap.

Daniel Barrett, MD · Answer

Dear Mojonz,
there is a lot of tummy tuck techniques and every plastic surgeon has his favorite. Some use drains others don't. In case of drainless tummy tuck, there is increased risk of seroma formation. If you are considering a surgery, I would suggest you to consult a board-certified plastic surgeon. Only after a thorough examination you will get more information and recommendations.
Daniel Barrett, MD

Steven Vath, MD · Answer

I am baffled by the number of surgeons who still use drains. I have been doing drainless tummy tucks for more than 12 years, and I can tell you that there are no additional risks with this technique. Actually to the contrary, the risk of seroma is the same and the risk of infection is lower.Additionally, there should be no increased cost for this technique. Surgical time is marginally increased by 5 to 10 minutes, so this should not affect the OR or the anesthesia costs.Here's how it works:In a traditional tummy tuck procedure, drains are used to prevent fluid accumulation in the “open space” created beneath the abdominal flap (skin and fat) and above the muscle. Through a fairly simple modification of the surgery—the use of progressive tension sutures—this space can be eliminated. 
The use of progressive tension sutures secures the abdominal flap to the underlying fascia, distributing tension over a larger area. This prevents seroma formation as there is no longer any space in which fluid can accumulate. Furthermore, with this technique, tension is spread out, rather than concentrated at the wound closure site, so, not only does this approach allow for the procedure to be done without drains, it decreases the risk of other complications associated with having most of the tension on the wound closure, such as hypertrophy of the scar.In my opinion, you should seek a consultation with a Board Certified Plastic Surgeon who performs tummy tuck with no drains.

Richard J. Restifo, MD · Answer

The drainless tummy tuck can be a bit more expensive.  If special tissue glue is used there is the additional cost of the glue, which is around 700 extra dollars.  If "progressive tension sutures" are used, this adds about 30 minutes to the operating time, which will increase the costs.  It is important to realize that the drainless techniques are best suited to patients at a nearly ideal body weight.  The major risk of a drainless technique is something called a seroma, which is an accumulation of the fluid that the drains would draw out from under the skin.  If a patient gets a seroma, it is no big deal but it may require the placement of a drain during the recovery period. Best wishes.

Olivier Deigni, MD · Answer

Hello and thank you for your question.
There are several ways to do a tummy tuck and each plastic surgeon likely does it a slightly different way. When I perform a tummy tuck I do not use drains and I have been extremely happy with the results. I use a technique called progressive tension sutures in which the sutures hold the abdominal skin in place and minimize the space for any fluid to collect. There are no extra risks when performed appropriately. 
The no drain tummy tuck makes recovery much easier for my patients. Without the drains, patients are able to walk after surgery without the worry of the drains being pulled on and it avoids any pain or discomfort associated with the drains at the skin where they exit. Another technique I use during my tummy tuck is injection of Exparel, which is a long lasting local anesthetic that I place along the muscles that are tightened to help with pain relief during the recovery process.
Sometimes a tummy tuck can be combined with liposuction and also surgery on the breasts such as an augmentation, a reduction, a lift, or a combination. You can expect most of the recovery process and activity restrictions to be directed by the tummy tuck especially with the muscle separation repair. You should plan for light duty with lifting no more than 5-10 lbs for 4-6 weeks to allow your body to adequately heal.
I recommend you seek a board-eligible or board-certified plastic surgeon who specializes in aesthetic plastic surgery. Make sure they discuss all your concerns including the risks, benefits, recovery, and postoperative course. 
I believe a key component of the consultation is to establish a good connection with your plastic surgeon. If you don’t feel like you have a good connection then they may not be the best surgeon for you.
Good luck!

Olivier A. Deigni, MD, MPH
Houston Plastic Surgeon

Pravin Reddy, MD · Answer

The stainless TT is not associated with additional risks when properly executed. The drainless TT is possible due the application of adhesive sutures that eliminates a potential dead space in which fluids can accumulate.  Another approach is preservation of lymphatic drainage by debunking the abdominal flap with liposuction before tucking the abdominal skin.

James Nachbar, MD · Answer

Like anything else, your mileage may vary, but I and my patients have been very happy with the no drain tummy tuck.  I have been using the no drain technique for all of my tummy tucks since 2008, and I highly recommend it.I have only used the suture technique, and have not had any experience using the glue technique.  The suture technique (the way I do it) probably adds about 30 - 45 minutes to the length of the procedure.  I place up to 40 or 50 separate sutures to eliminate the space where the fluid would otherwise collect and cause a seroma (fluid collection).  Another advantage of the sutures is that they tend to pull the skin flap downward, which we believe reduces the tension on the incision and should therefore reduce the thickness of the scar in comparison to what one would expect if there were more tension.Your comment about the drain being the most feared and dreaded aspect of tummy tuck recovery is exactly on target.  You can avoid all of the discomfort of having the drain in place for several weeks, as well as the discomfort of removing the drain, by avoiding the drain altogether.But even more important is the safety aspect of the no drain procedure: the most serious complications from tummy tuck (as opposed to the most common complication, which is seroma) are related to blood clot formation, and one of the best ways to reduce your chance of getting a blood clot is to get moving immediately after surgery.  Being able to avoid the drain helps with that, because it hurts less to move around after surgery when there is no drain.That is especially true when Exparil long-lasting (three or four days) anesthetic is also used to reduce the post-operative pain and reduce the need for post-operative opioid pain medication.  Combining the no-drain technique with the Exparil is a great way to reduce post-operative pain, and I believe increase your ability to move after surgery and thus reduce your risk of blood clots.I have to strongly disagree with those who talk about seroma needing to be drained when the no-drain technique is performed with sutures.  I have not seen the sutures pull out, and I do not see seromas following tummy tuck when the no drain technique has been used the way I use it.  On the other hand, seroma is the most common complication of tummy tuck when a drain is relied upon to try to get the skin and fat to stick down to the muscle.  As I explain in the video, when there are no sutures holding the fat down to the muscle, every time you move you tend to pull them apart.  Although I have heard that some surgeons claim that they can remove the drain after only a week or so, all of the articles I have seen have shown that seroma occurs more often when the drain is removed that early, and even occurs when the drain is left a full three weeks.Now, it certainly is true that the no-drain technique, especially with sutures, is harder and takes longer than the ordinary drain technique, and there is definitely a learning curve to become proficient in the no-drain technique.As I mentioned, I do not have experience using the glue technique; although I looked at it when it came out (I had been using the suture no-drain technique for many years already when the glue came out), the studies that the glue company provides all seem to indicate that many of the patients who have the no drain technique with glue still get seromas that needed to be drained with a needle.  Again, I do not have experience using the glue, but since I don't see seromas with the suture technique, I would not want to go backwards and adopt a new technique with a reported incidence of seroma formation higher than I am seeing using sutures.Please take a look at the video, where I discuss this further, but I strongly suggest that you give full consideration to having a no-drain tummy tuck if you are planning a tummy tuck.Good luck with whatever you decide!

Ethan E. Larson, MD · Answer

Drainless tummy tuck is a procedure designed to provide all the benefits of a tummy tuck procedure, without the use of a drain or drains.  In order to accomplish this, typically the abdominal tissues are tacked to the underlying abdominal wall fascia and musculature.  This avoids sliding between these two tissue planes and diminishes the post-operative fluid produced by the body.  Without drains, there can still be an increased risk of fluid accumulation if these sutures tear out (this is called a seroma.)  Occasionally these fluid collections need to be drained with a needle in the office.  Also, the sutures into the abdominal musculature can be more painful.  Finally, these sutures can produce visible dimpling in the skin.  These dimples are almost always temporary, (2-6 weeks).  I hope this helps.
Ethan E. Larson, MD

Emile Brown, MD · Answer

I routinely perform drainless tummy tucks in all my patients. Multiple studies with large numbers of patients have now shown drainless tummy tucks to be very safe - some have even shown decreased rates of postoperative fluid collections (seroma). They can take a bit longer to perform so the cost may be a bit higher, but in my opinion it is well worth it. Best of luck with your procedure!Emile N. Brown, MDJohns Hopkins & Harvard Trained Plastic Surgeon

Jason Pozner, MD · Answer

We have been using cohera glue for about a year now with drainless tummy tucks. It works best on thinner patients and if you do not do a lot of simultaneous abdominal lipo (flanks ok). Risks are that you get some fluid accumulation that you need to drain with a needle. We have had to do this but not that often and even if you use drains I have to drain occasionally after drains are pulled anyway. the incisions seem a little lower and the scars are better as there is less tension pulling up on the incision. Costs are about $600-$750 or so higher as that's the price of the glue and you have to let it sit 10 minutes so there is a little extra anesthesia time.

Drainless tummy tuck... Are there extra risks?

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