Drainless Tummy tuck or not?

Any cons going the "drainless" tummy tuck route? I like that it's faster recovery and no hassle with the drains post surgery but what could go wrong or is it safe?

Doctor Answers 18

To drain or not to drain

Great question.  Each doctor has his/her own preference for the type of tummy tuck and the use of drains.  In general, not using a drain will require one or more of the following:
-quilting sutures
-internal adhesive
-leaving a layer of fat behind

My personal opinion is that the waist and abdomen look more refined when the fat is thinned out and removed.  When this occurs, a drain must be used.  I think the recovery is about the same regardless of which route you go.

All the best,

Dr. Remus Repta


Scottsdale Plastic Surgeon
4.9 out of 5 stars 154 reviews

Drainless Tummy tuck or not?

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

Cons to drainless tummy tuck

The only con for drainless tummy tucks that I have seen is that it takes a few more minutes to complete the surgery. For the patient, I have only seen benefits. The seroma rate in my practice is actually lower than when I used drains. The pain after surgery is the same. The swelling is about the same. The bruising is about the same. But patients invariably say that they are thrilled to avoid the hassle of having drains. I also think that my scars are slightly better with progressive tension sutures than without.

Wm. Todd Stoeckel, MD
Raleigh-Durham Plastic Surgeon
4.8 out of 5 stars 80 reviews

Drainless tummy tuck or not?

There are excellent surgeons who perform tummy tucks with or without drains and the final results are likely very similar. However, there is research that shows that there is a lower rate of seromas (blister fluid collections, the very thing drains are supposed to prevent) with the use of the No Drain Tummy Tuck.

Pros: (it's just easier for the patient)
Lower seroma rate 
No drains, which can be there for up to 2 weeks (to have to drain and log output, to have to be worried that you pull on them because if you do they will hurt)
No additional scar from where the drain comes out (even if the drain comes out the sides, it still leaves a wider scar than if no drain were ever there. 
No pain when removing the drains, as there are none...
Likely earlier return to normal activity (based on preliminary data from a prospective study)
Possibly a little less pain (based on preliminary data from a prospective study)

Cons:
Extra 23 min of operating time

I thin out the fat when performing the no drain tummy tuck with a combination of aggressive liposuction (up to 5 liters) and direct excision of fat. 

We recently published our center's experience of over 450 tummy tucks during the period where we switched to the No-Drain approach, and it showed the the seroma rate was decreased from 9% when using drains to 2% when using the progressive tension sutures and no drains.

It is absolutely safe and my prediction is that drains in tummy tucks will eventually be a thing of the past as more surgeons get trained in the technique.

But in the end, finding a surgeon who is Board-Certified by the American Board of Plastic Surgery who you feel can provide the results you are looking for is more important that whether or not he or she uses drians with the tummy tuck as the final result will likely be similar. 

I hope this helps and best wishes.

Brainless Tummy Tuck

Hello,

Dr. Singer is right that excellent surgeons do either, but the data suggests that drainless is better, which I have found in my personal experience. Here's why: The difference has more to do than whether a drain is used. With a drainless tummy tuck, internal sutures are used to fasten the skin flap down to the muscle, preventing shearing (sliding) of the two surfaces, the cause of seromas after the drains are removed.  Just as important, these internal sutures, known as quilting or progressive tension sutures, begin the tightening process in a stepwise fashion up by the rib cage.  This gets maximum tightening along the entire skin 'flap', which I have found increases upper abdominal tightness after healing, minimizing complaints of persistent laxity in the upper abdomen.

Recovery from this surgery is about the same as liposuction of the abdomen, with the exception of avoidance of targeted abdominal exercise for 8 weeks if there was muscle repair with the tummy tuck. 

A few extra notes after reading my colleagues responses: 1. small tummy tuck or extended, drains are not necessary. 2. Associated liposuction (something I do in almost all of my tummy tucks) do not require drains. 3. Data shows much lower rate of seromas compared to tummy tucks with drains.  My personal experience is 1 seroma in about 250 tummy tucks without drains in the last 6 years.  Prior to that it averaged 10% to 20% of the time!  I got very tired of seeing my patients come in with seromas!

Best of luck!

Gerald Minniti, MD, FACS
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 79 reviews

Drainless Tummy tuck or not?

I have been using drains routinely on all TT's for the past 28 years.  However, at the recent Aesthetic Society meeting there was much emphasis on using progressive tension sutures, thus eliminating the dead space and the need for drains.  Many studies have shown an equal incidence of seroma between the two techniques.  

Ruben B. Abrams, MD, FACS
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 17 reviews

Drains and tummy tuck

Thank you for your question. Drains are typically the least favorite part of any plastic surgery procedure. Drains however, can play an important role in your care. I typically place a drain in all of my tummy tucks because I feel that even with quilting sutures and leaving some residual fat there is still a chance of developing a seroma. My philosophy is that it is better to have a drain for a few days than to develop a seroma and require aspiration. Best of luck. 

Arun Rao, MD
Tucson Plastic Surgeon
5.0 out of 5 stars 15 reviews

No right answer

As with most plastic surgery procedures, it is impossible to give you a definitive answer to your question without first seeing you in consultation and doing a complete examination.  There are so many considerations whether to drain or not - not the least important is how far away from your surgeons office do you live?  If a drain is not used, but you develop a fluid collection (seroma or hematoma) you will need to return to the doctors office every two or three days for a needle aspiration of the fluid until it stops, or a drain will have to be placed in the office anyway.  Get at least two or three opinions on this question.

Jeffrey Ptak, MD, FACS
Phoenix Plastic Surgeon
4.7 out of 5 stars 7 reviews

Drainless tummy tuck, is it ok?

 Thanks so much for your question. Short answer is yes it's a great alternative to the traditional tummy tuck technique. It's something that I use in my practice routinely. I think that in the right circumstance it definitely shortens recovery time and is obviously more appealing than having to have a drain for the first few days postoperatively. Part of it depends on what exactly is being done (i.e. if liposuctiin is being performed, overall size of patient, ect). However it's a very common way to perform that surgery now days. Hope this helps. 

Shaun Parson, MD
Phoenix Plastic Surgeon
4.8 out of 5 stars 42 reviews

Drains

I use drains for my tummy tucks.  It's best in my humble opinion.  They are removed after about one week.  Ask a board certified plastic surgeon. 

Andrew T. Cohen, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 37 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.