What are the cons to a drainless tummy tuck? What could go wrong?

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 timeI 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.

Our meta-analysis research (link below) showed that "drainless tummy tuck (abdominoplasty) with progressive tension sutures" were more effective than tummy tuck with drains in reducing seroma (fluid buildup) and reoperation rates, with no difference for hematomas or infections. The potential con is contour deformity and dimpling if the sutures are not placed correctly by an experienced surgeon.
Many plastic surgeons continue to use drains during tummy tucks because it has been the standard practice for many years. Drains are traditionally used to prevent fluid accumulation under the skin, a common occurrence after the procedure. The accumulation of fluid, known as a seroma, can slow healing and lead to complications. Using drains helps remove this fluid, ensuring proper healing and minimizing the risk of complications. However, drains can be uncomfortable, require additional care, and increase the risk of infection at the insertion points. They can also leave scars, even after they are removed.
The advent of the "drainless" tummy tuck, typically achieved through the use of progressive tension sutures, offers an alternative to this approach. These sutures help to close any dead space in the skin flap, significantly reducing the likelihood of fluid buildup and seromas. This technique not only eliminates the need for drains but can also result in faster recovery times and less post-operative discomfort for patients. While it has been shown to be highly effective, it is not without its challenges, such as a slightly longer surgical time and the need for a highly skilled surgeon to perform the procedure. Some surgeons may still prefer to use drains out of familiarity or due to concerns about fluid accumulation, especially in patients with certain body types or those undergoing significant liposuction. However, as more evidence supporting the benefits of drainless tummy tucks accumulates, this method is becoming increasingly popular for its enhanced patient comfort and streamlined recovery process.
While not every patient is a suitable candidate for a drainless approach, the procedure has proven to be a highly effective option. Your plastic surgeon needs experience in this technique, because incorrect placement of the sutures can cause major problems including contour deformities and possible need for re-operation. Be sure to consult with an experienced plastic surgeon to determine if a drainless tummy tuck is right for you!
Krishna Vyas, MD, PhD, MHSHarvard, Hopkins, & Mayo Clinic Trained Aesthetic Plastic SurgeonNew York, New York

In order to avoid using a drain during a tummy tuck, a surgeon generally places multiple rows of deep resorbable sutures under the skin, which act to eliminate any dead space and prevent shearing forces between the abdominal wall and the skin flap. This decreases the chance of developing a fluid collection (seroma) after surgery and makes drains unnecessary.  In my opinion, the pros vastly outweigh the cons and I generally perform only "drainless" tummy tucks. I also routinely perform extensive liposuction at the same time as the tummy tuck.
Pros
+ increased patient comfort/convenience from having no drain after surgery
+ decreased rates of seroma
+ less tension on abdominal skin closure, which may result in better scars long term
Cons
+ takes a bit longer in the operating room
Emile N. Brown, MD
Board Certified Plastic Surgeon, Johns Hopkins & Harvard Traine

Like all surgery, it has to be done right.   When it is, it provides all the advantages of a rapid, more comfortable recovery with none of the disadvantages of drains. Drains do not prevent seromas in a significant percentage of cases, and seromas require aspiration, often 2-3 times, and further measures including surgery if they do not resolve.  Although a small seroma may occur with the use of the drainless progressive-tension suture technique, it is likely to be small and easily  resolved with aspiration or a seroma catheter.  All the risks associate with fluid collections shift in the downward direction of frequency and/or severity.
The sutures should be placed nicely so they do not tether or dimple the skin, and they should be sufficient to do the job of closing the open space created when the flap is elevated.
Drainless
tummy  tucks are an integral part of my procedure.  Even with drains
or tissue glue there is a a 5-45 % incidence of seroma per the literature. A
meta-analysis in the Aesthetic Surgery Journal, 
Aesthet
Surg J. 2017 Mar 1;37(3):316-323. doi: 10.1093/asj/sjw192.
Seretis
K, Goulis, D, Demiri EC, Lykoudis, EG
Prevention
of Seroma Formation Following Abdominoplasty: A Systematic Review and
Meta-Analysis
reviewed
all the literature on this topic, and found that "preventive
measures" decreased the incidence of seroma four-fold. One of the studies
included in the "preventive group" that
used only progressive tension sutures, from 2006, showed fluid
accumulation between the sutures, detected only on ultrasound. This fluid was
not clinically detectable by palpation or inspection and resulted in no need
for seroma aspiration or any complication. The total amount of fluid associated
with clinical complications including drainage in the other groups was
greater than 80 cc, and the total amount of non-clinically
detectable fluid in the progressive-tension group was always 80 cc or
less. The use of drains plus progressive tension sutures did not change the
amount of fluid, so there is really no benefit to using drains plus progressive
tension sutures.
The
study was discussed by Pollock and Pollock, who noted that in their series of
565 patients using progressive tension sutures they never had a clinically
significant seroma. When a seroma occurs, it may require multiple visits and
aspirations, and if persistent, introduction of antibiotic sclerosing
solutions, or reoperation to remove a fluid filled fibrous cavity. The
drain opening may leave a scar in the incision or pubic mons which may become
pigmented or depressed. Not having to use drains spares the patient and plastic
surgeon from the chance of these undesirable events and/or outcomes.
My
experience mirrors that of Drs. Pollack.  I have had no clinically
significant seromas while using progressive tension sutures in the past
five years or so.
Rather
than use the 15-20 individually-placed sutures described by Drs. Pollock,
I completely close the dead space with continuous PDO and monoderm Quill
sutures. These sutures effectively reduce the dead space to almost nothing, so
even the small amount of fluid that might collect between the sutures, cannot
create any significant seroma. Using running Quill sutures allows relatively
rapid dead space closure as no knot-tying is needed. The umbilical location is
confirmed with a Lockwood flap marker before the lower abdominal closure is
completed.

A drain-less tummy tuck is not fool proof (nothing is), it takes a bit more time under anesthesia to place these stitches and a girdle is generally worn immediately but it does seems to work well. Patients tend to like this as there is no drain care and they can shower earlier. There may be slightly more swelling, more of a chance for seroma in some but in the long run (after 1-2 months) no difference in the swelling of those with and those without drains. On the other hand use of drains in my experience is a quicker operative time, early on prevents seroma and minimizes bruising, easy and painless to remove postoperatively, no need to wear the elastic garment/girdle until the drains come out in my practice.
#tummytuck#TT

The #drainage tubes for a tummy tuck are used by trained Plastic Surgeons for many different operations. The purpose is to drain extra fluid which may otherwise accumulate under the skin, fat or muscle following an operation.  Patients generally find this annoying and uncomfortable and they can impede mobility and therefore slow aspects of #healing. Over the years, surgeons have improved procedures and found ways to eliminate the need for these #drains in a variety of operations; including #tummy #tuck or #abdominoplasty.I have found that most of my patients do very well with the exception of those have large areas of liposuction or lipo-abdominoplasty.  I may use drains on a case by case basis for these patients. A newer option now can include the use of tissue #glue to adhere the abdominal #skin to the #muscle; eliminating any space that previously required a drain.Information that you read online may not apply to your personal situation. All surgical procedures carry some degree of #risk. Always discuss your issues and concerns with the Plastic Surgeon during and following your consultation. The suitability of your procedures and any specific risks may be determined during you #consultation. Also, another element to a satisfying result of your procedures are realistic #expectations. The best method and #technique for your #procedures will be discussed in greater length during your one-on-one consultation with a board-certified plastic surgeon.

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.

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!

Good Morning and thank you for sharing your question on RealSelf.com.I have always used drains with tummy tuck procedures.  They are easy to care for and are removed without pain.  I do believe they are essential with an aggressive tuck that gives you better results.Some doctors do not use drains and then have to do more work within the tummy wall to avoid a fluid collection.  Scientific studies do show that the incidence of seroma (fluid collection) is low with that technique.I prefer to drain and my incidence of seroma is quite low.  I do not believe that drainless tummy tucks heal any quicker than those with drains.Good luck to you and get advice from several experienced, board-certified plastic surgeons.  Be sure to ask to see before and after pictures as well.Dr Spies

Plastic surgeons have been using drains for decades to control fluid accumulations that occurs after surgery called seromas. These drains are pieces of plastic tubing that are put inside your body and come out through a small hole in the skin where the fluid is collected in a suction container. Often times they are the most painful part of a procedure as the drain goes through the skin, which is the most sensitive part of your body.  They are also often the most annoying part of the entire surgical process because for weeks after the surgery they have to go in the shower with you, to work with you and to dinner with you. There are some reconstructive procedures in plastic surgery where leaving a drain is important, but for most cosmetic procedures done today, drains are a relic of the past.  This is especially true for abdominoplasty where appropriately placed "progression tension sutures" eliminate the need for a drain entirely. I also perform "lipoabdominoplasty" procedures without a drain that allow me to liposuction the abdomen and the flanks and give that great hourglass shape with a low scar.