Drainless Tummy tuck or not?
Doctor Answers 18
To drain or not to drain
-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
Drainless Tummy tuck or not?
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
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.
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Drainless tummy tuck or not?
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)
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
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!