About No Drain Tummy Tucks
Thank you for your question.
During a tummy tuck surgery, there is space between the abdominal wall and the overlying fat and skin (the abdominal flap). The body will do what it usually does during the healing process, produce fluid, if nothing is done to close this space. Because there is nothing to confine the fluid from accumulating, a seroma can develop in this space. In other words, the tissue produces fluid more quickly than it can reabsorb.
Negative suction drains are placed in spaces like this to get rid of the fluid and create suction between the tissue planes. There is a way, however, to eliminate this space without using uncomfortable drainage tubes. Dr. Patel utilizes progressive tension sutures inside the tissues to close off the space and relieve tension on the last surgical closure. This results into less pain, less discomfort and less tension. Also, there will be better scarring with potentially minimizes infection risk.
We have successfully used progressive tension sutures during abdominoplasty instead of surgical drains, with a lower seroma rate than is generally thought to occur with tummy tucks and drains. With this method, the seroma rate is close to zero and you cannot beat that approach. Best of luck!
Dhaval M. Patel
Double Board Certified
Both Acceptable Techniques
As other specialists have pointed out, the use of drains doesn't have a significant effect on the results. I prefer to use drains at my Las Vegas practice, because I believe they provide an extra measure of safety during a patient's recovery. Drains remove fluid that naturally fills the pocket created under the skin during the tummy tuck. A no-drain tummy tuck involves suturing the cavity closed, preventing the fluid from collecting. That said, the overall experience and training of a plastic surgeon, paired with a proven record of good results, matter more than the technique.
Both will give you the same result
It's not a matter of how your surgery will turn out. The only difference is in the first couple of weeks. Tummy tucks involve making a big pocket under the skin so we can remove a bunch of skin. The body's response to that is to fill that cavity with fluid. Drains remove the fluid until it heals -- usually in for no more that a week. Some surgeons suture that cavity closed with "quilting sutures" so that no fluid will collect, so no drain. However, neither is fool-proof. It's a nice perk when it works, but I wouldn't chose a surgeon based on this alone. Good luck!
I prefer to use drains. Some surgeons do not use drains as they modify their technique using what are called quilting sutures. Best of luck.
Drain v. Drainless Tummy Tuck
I do not use drains any more with this procedure and have switched from pain pumps to Exparel which is a long acting injectable pain medicine like Lidocaine or Marcaine but lasts for three days. This is injected all along the muscle and skin to provide pain relief. This is termed the Pain-less, Drainless Tummy Tuck.
If you go to a doctor who uses #drains, they usually stay in 3-5 days but may be required to remain in longer.
So, there is the option for a drain-less tummy tuck, and you can see the details here in the video attached.
Thank you for your question. I was just explaining this to the nurses in the operating room today. First, a patient must be a good candidate for a drainless tummy tuck including normal weight with relatively little fatty tissue. The heavier the patient, the more fluid will be produced in the surgical sights. Second, the progressive tension suture (or quilting suture) technique must be utilized in order to help eliminate the space where fluid is produced. If a patient is too heavy for the drainless tummy tuck, employing the progressive tension suture technique will allow the surgeon to place one drain instead of the typical two drains used for the standard tummy tuck. Hope this helps. Consult with a board certified plastic surgeon experienced with this technique to determine if your are a good candidate for the procedure.
Drain or No Drains after TT
Historically, TT required drains to aid with the fluid that was accumulating under the skin. A quilting technique has been introduced where the skin/fat is sutured back down to the muscle/fascia and has allowed us to eliminate the drains. The drains are inconvenient more than anything. Some patients are not candidates for the approach. It is best to meet with a board certified plastic surgeon or two and have surgery with the doctor you feel most comfortable with regardless of their choice of drains.
Drains are used to avoid fluid accumulating under the skin after the surgery that may need to be aspirated or if it becomes chronic, lead to revision surgery. By placing quilting sutures the use of drains can be avioded although seromas can still occur. In my opinion the use of drains is a minor inconvenience that can avoid a much larger inconvenience in the future. Best wishes, Dr. T.
What is the difference between a drain and a no drain tummy tuck? Which one is better?
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
Thank you for the question. No drain tummy tuck has been increasingly popular because it is effective if done correctly with 'progressive tension sutures' or simply quilting sutures to minimize the space under the abdominal wall after it's been separated from the underlying muscle to pull it down. This technique minimizes seroma and allows for better adherence and contouring of the abdomen, and of course the obvious less pain and discomfort of the drains so one can shower the next day after surgery without the inconvenience of drains.
Drains have never been proven to prevent hematoma or seroma. However they have been linked to infection because they connect the inner sterile abdomen to the outer not so clean skin. So their presence was questioned. For the past two years I have not needed to use drains for all my abdominoplasties including the extended ones. My patients are happy to move freely without pain and shower early after surgery without compromising their result.
Please consult with a board certified plastic surgeon who is extensive experience with this procedure and who can help you achieve your goals.
Best of luck!