3 Weeks Post Op TT Draining 50cc's a Day, What Are my Options?

Thanks for sharing. Given your situation it appears you have a lymphatic leak and if the drain is removed you develop a seroma cavity. A good option sometimes is to perform a sclerosis, which involves injection an antibiotic into the abdomen via the drain. This can create additional scar tissue and seal the leak. A side effect of the procedure is infection and pain. Lymphatic leaks tend to occur most often in weight loss patients, so it's not that unusual. Discuss all these options with your PS. Hope this helps - Dr. Aldo.

The vast majority of mommy makeover patients have their
drains removed within two weeks of their surgical procedure.  We generally wait until the drainage has
dropped below 25cc in a 24 hour period. 
Unfortunately, some patients have persistent drainage for longer periods
of time.  In some cases we’ve seen
patients drain for four to six weeks. 
When this situation arises we worry about the potential for infection,
since these drains are a two way street.

                When
this situation arises we continue the use of compression garments and minimize
activity levels.  Rarely sclerosing
agents are used to decrease drainage. 
Occasionally none of these treatments work and the surgeon is left with
a difficult decision.  In these cases,
drains may actually stimulate drainage. 
Under these circumstances the surgeon may elect to pull the drains even
though the drainage is still high.  If
fluid accumulates percutaneous aspirations can be used to address the
problem.   It’s important to maintain
close contact with your surgeon.  Your
surgeon should be able to formulate a treatment plan that successfully manages
this problem.

 

    3 weeks and higher output still may resolve in the next week.  At 4 weeks, a sclerosant could be injected. 

Persistent drainage 3 weeks after tummy tuck is a bit unusual. Most of my patients had their drains out by 7 to 10 days after the surgery. You may want to check with your surgeon to see if the drainage has anything unusual. How is the characteristic of the drainage? Is it clear or murky? Any foul smelling odor? Is it still bloody? Is your lower abdomen still quite swollen? Are their fluid collection under the abdominal skin?

Best Wishes, 

Stewart Wang, MD FACS

Thank you for your post. Whenever there is a potential space in your body, your body tends to fill that space with serous fluid (the yellow type of fluid that also comes out of a 'weeping wound'. This is similar to when you get a blister: the layers of skin separate and fluid is deposited in to the space. In a tummy tuck, the space is in between the skin/fat layer and the muscle layer. Most surgeons will place a drain to remove this fluid while your body is secreting it until the fat layer grows back together with the muscle layer. At that point, no more fluid is secreted into the area, because there is no more space for fluid. The length of time that this takes varies from patient to patient. Some patients heal much faster, thus the layers seal together much faster. Also, the more twisting motion you have in your belly area, the slower the two layers grow back together because they are moving in relation to each other. The fluid coming through the drain can be initially dark red, and eventually clears to pink then yellow. This is because it takes just a little bit of blood to make the fluid dark red. Also, initially, there can be a large amount of fluid (few hundred cc's in the first day is not out of the range of normal) and this should slow down substantially over next few days. Once the fluid slows down to the amount that your surgeon is comfortable with (usually 25-50 cc in 24 hours) then they will be pulled. There is minimal discomfort in pulling the drain in most patients. More recently, 'drain free' surgery has become more popular. Fat layer is sutured down to the muscle layer starting at the ribs and progressively down to the lower incision. This makes the space for the fluid to collect much smaller, and in many patients can have surgery without drains. However, I have seen multiple patients come from other surgeons because they developed a seroma despite the suturing of the tissue. This is not the surgeon's fault, but some patients just do not heal fast enough or put out too much fluid for the body to absorb. Best wishes,Pablo Prichard, MD

Sorry to hear about the continued relatively high output from your drain after tummy tuck surgery. As you can tell from the variety of responses you have received, there are many different ways to handle your situation.  Your plastic surgeon will be in the best position to advise you precisely after careful clinical evaluation.

 In my practice, assuming there is no sign of infection around the drain site ( explaining your discomfort/pain),  I would probably ask that we leave the drain in place  for a longer period of time.  I have had to do this on occasion,  and so far, have not regretted  doing so.

 In my practice, I would not move on to the use of sclerosing agents at this point.

 I hope this helps.

Thank you for the question. This is not the usual post operative course after abdominoplasty (tummy tuck). Most patients will have had their drains pulled after the first week to 10 days post-op. This persistent drainage could be indicative of other processes and therefore one needs to evaluate not just how much drainage but also the type of drainage (purulent, bloody, serous).

Continue to follow up with your plastic surgeon as they may need to introduce a chemical sclerosant that will help to scar down the tissue and seal off the space and/or start you on antibiotics.

Best of luck.

Given your relatively high drain output per day, I would suggest you direct this question to your plastic surgeon. I would continue with your compression garments.  Make sure your PS checks to make sure your garments are giving you adequate compression.  If the drain output remains high in another week, I would likely suggestion treatment with doxycycline.   One option to help decrease high drain out is to flush the drain with an antibiotic solution (doxycycline) to help scar down the empty space where fluid is building up.  Your plastic surgeon may have a different but similar regimen.  Please followup with your PS this week.

Dr. Basu

Houston, TX

Although my usual threshold is 30 cc/day for drain removal, after a certain amount of time it is reasonable to remove the drain anyway. 

I sometimes do a trial of sclerosis, injecting betadyne and allowing it to dwell for 15 minutes off suction, once or twice before removal. This sometimes sets up an inflammatory process that makes the edges of the fluid forming tissues stick to one another and stop secreting the fluid. Wear your binder after the drain is removed, and follow up with your surgeon at the earliest sign of swelling.

Thanks, best wishes. 

 

Hello,

Thank you for the question.  If you are not seeing a steady decrease in the amount of fluid the drain is putting out it may be time to pull it out.  At three weeks after your surgery you are about 10-14 days past the time I usually see drains still in.  After the drain is removed you should wear your abdominal binder for about 24-48 hrs straight and have your plastic surgeon check you for a seroma accumulation.  It may be that you have some activity within your surgical site that is contributing to your fluid drainage.  This is hard to know until the drain comes out and we see how your body reacts.

All the best,

Dr Remus Repta