Tummy tuck with no drains and under local anesthesia?

Question

I’m thinking of getting a tummy tuck with no drains and under local anesthesia. Are blood clot risks reduced with local vs. gen? I’m really scared of getting blood clots.

Fernando Colon, MD · Answer

Thank you for your question.  A traditional tummy tuck should be performed under general anesthesia to adequately address the concern of excess skin, muscle relaxation and placement of the belly button.  Alternative techniques are available for lesser cosmetic corrections.  Those can be addressed with sedation and tumescent anesthesia techniques.  In general; there is a greater risk of DVT with general anesthesia and longer procedures. Body mass index is an important measurement of risk for blood clots.  A consultation with a board certified plastic surgeon will help in determining your risk and best ways to prevent blood clots.  Best wishes!

Stephen T. Greenberg, MD, FACS · Answer

Thank you for your question.  I do not recommend having a tummy tuck done under local anesthesia.  After having any surgical procedure you do have a risk of blood clots.  I would recommend having an in person consultation with a Board Certified Plastic Surgeon to evaluate you and make a recommendation.  Best of luck to you.

Richard G. Schwartz, MD · Answer

Although a tummy tuck could possibly be done under local (tumescent) anesthesia with iv sedation (twilight anesthesia), I doubt anyone would perform this surgery just under straight local without sedation.  The usual technique is with general anesthesia, but I have done this under iv sedation and tumescent.  With the use of quilting stitches to close off space below the skin flap, drains are not necessary.  The risk of blood clots is related to any pre-existing risk factors such as your weight, past history of blood clots, and the length of the surgery.  If you are obese, I would consider using a blood thinner as a precaution in addition to stockings that pump up and down to keep blood flow moving normally in the legs.

Gregory DeLange, MD · Answer

You are very unlikely going to a Board Certified Plastic Surgeon if you plan on having it done under local anesthesia.   The drain use is not  big concern and can be done with our without.  Blood clots are EXTREMELY rare.  I have never seen one in 22 years and 12,000 cases.  Most importantly, go to someone highly trained who is Board Certified and NOT in cosmetic surgery.  Go to a real Plastic Surgeon.

Harry T. Haramis, MD, FACS · Answer

A full, formal tummy tuck with muscle tightening is NOT recommended under only local. Tummy tuck should be respected as a big surgery and performed safely with full anesthesia for best results.Proper patient selection, scd, fluids, etc and early post op walking will keep blood clot risk low.Use of drains or not depends upon the surgeon's technique and should not have any bearing on anesthesia.An exam and consultation with a plastic surgeon is recommended to discuss your options and expectations.

Kenneth Hughes, MD · Answer

Although the TT can be performed under local anesthesia, this procedure can be extraordinarily painful for the patient.  The patient's pain threshold and anxiety level should be taken into consideration.  You want the most dramatic transformation possible, and you also do not want to be in pain during the procedure so that the surgeon must stop the procedure or do less than what is necessary.  If you move or tighten your abdominal muscles, you may compromise results.Blood clots after TT are not common.  Blood clots that lead to pulmonary embolus are even more uncommon.  However, if you have more than one risk factor for blood clots other than having a TT surgery, you may need Lovenox or something similar.  Your plastic surgeon should be familiar with the Caprini assessment, and he or she should be able to determine if this is indicated.Leave the decision regarding drains to your PS, as he/she will determine what is appropriate for you based upon his/her experience, education, training, and personal preferences.  Kenneth Hughes, MD, Board Certified Plastic SurgeonLos Angeles, CA

Thomas Trevisani, MD · Answer

Abdominoplasty is a serious, complex operation that - in my opinion- should be performed only under General Anesthesia. In addition, the muscle tightening is best done with full muscle relaxation during the operation , which can only be achieved with muscle relaxation medication administered while the patient is fully asleep and their breathing is controlled by Anesthesia Provider. I would be suspect of any Surgeon offering a full Abdominoplasty under local Anesthesia. If your Surgeon is offering you local Anesthesia-- that could be that he/she is not permitted to perform any surgery under General Anesthesia. I would start by checking with American Board of Plastic Surgery if your Surgeon is Board Certified and then which Hospital affiliations he/she has.

Nelson Castillo, MD · Answer

Thank you for sharing your question.  For most patients a tummy tuck should be performed under general anesthesia, for both safety as well as patient comfort.  A tummy tuck involves manipulation of several layers of tissue that would be hard to numb with local anesthesia alone.  Your risk of blood clot formation needs to be determined based on your general health as well as other known factors.  Talk to your surgeon and revisit this discussion with them.

Camille Cash, MD · Answer

I perform my tummy tucks under general anesthesia and with drains.  This is for my patients' safety and to optimize results.  General anesthesia allows your surgeon to focus on getting you the best results while the anesthesiologist keeps you comfortable and safe.  Drains are used to minimize complications from seromas which can be problematic and even at times lead to the need for further surgery.  While it may sound more palatable to have a tummy tuck with only local anesthesia and no drains the benefits do not outweigh the risks.

Michael Eisemann, MD · Answer

Hello and thank you for your question. Tummy tuck procedures are most often performed under general anesthesia not local anesthesia, so you will want to discuss your surgeon’s rationale for recommending local anesthesia understanding that this not the accepted protocol for this surgery. Further, blood clots are an extremely rare side effect of surgery and are not a known side effect of general anesthesia. Since this is the case, you need not avoid having general anesthesia for this reason. Schedule an in-person consultation with a board-certified facial plastic surgeon to discuss your tummy tuck procedure and anesthesia options in greater detail. Best of luck!
Michael Eisemann M.D.
Plastic Surgeon
Houston, Texas

Tummy tuck with no drains and under local anesthesia?

Answers (19)

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