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

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.