What are the pros and cons to having or not having drains?

Question

I had a consult between 2 doctors for tummy tuck lipo breast reduction and fat transfer. One uses drains and the other does not.

Michael Zwicklbauer, MD · Answer

I think all plastic surgeons like to limit the use of drains. They are really inconvenient and annoying for our patients. Personally in a breast reduction ,unless it is a massive reduction, I do not use drains. I found it works out just fine without any drains. For an abdominoplasty ,  however ,I have done it with and without drains and I’ve gone back to using just one drain now. The main reason I use the drain is because I put all my tummy tucks on a blood thinner postoperatively to prevent blood clots which can move to the heart and lungs and kill you.  As a result a drain will let both the patient and me know if they are bleeding postoperatively while on the blood thinner.  Just like to be safe.

Steven Sigalove, MD FACS · Answer

Hi there, thank you for this great question. Generally speaking I don’t use drains. For a breast reduction I do not leave drains. For a tummy tuck, I do leave a drain in for about a week. Drains can be very mandatory to reduce the likelihood or post-operative seroma formation which is a large fluid accumulation that happens between the skin flap and the muscle. If you get a seroma, it has to be aspriated after surgery, which prolongs healing and recovery time.

There is a “drainless tummy tuck” that some surgeons offer, but there still is a potential risk of post-operative seromas with that technique.

There is a “drainless tummy tuck” that some surgeons offer, but there still is a potential risk of post-operative seromas with that technique.

T. Randall Blanchard, MD · Answer

The benefit of drains is that they will help prevent fluid collections at the operative site. The down side is that they are inconvenient and sometimes even painful at the drain site. The use of drains by a specific surgeon is a personal choice based on their own experience. I personally would NOT chose my surgeon based on this criteria alone. The drains (if used) will be out in a few days but the results from your surgery (good or bad) will last a lifetime. I would chose my surgeon based on reviews, recommendation of local medical providers, board certification, whether they operate in an accredited facility ...., NOT whether or not they use drains.

Peter J. Vonu, MD · Answer

In my years of practice I have found that the benefit of having drains outweighs the inconvenience that they may cause.They in many cases expedite recovery by limiting fluid accumulation. They can be an indicator of bleeding or infection post operatively. Of course not all cases require a drain but if your surgeon feels that they are necessary in a given case I would not discourage the doc from using them.

Kenneth Hughes, MD · Answer

I definitely would not select your PS based upon the presence or absence of drains.  I would search for the board certified PS who you feel is most likely to give you the best results and who performs hundreds of these procedures each year. I would look at patient reviews as well as before and after photos on that PS's website.PS have their own preferences for using/not using drains based upon years of training, experience, and education.  I use drains in very few procedures.  If you have a fluid collection that needs to be drained after a TT, this can compromise the incision and healing.Kenneth Hughes, MD, ABPS Board Certified Plastic SurgeonLos Angeles, CA

Mel T. Ortega, MD · Answer

crystal8182 Hi There , Thank you for your Question 
Many surgeons, including myself, offer online virtual consultations where you send us your photos and we can estimate the cost. I, like many surgeons, also offer free consultations so that you can be examined and given the most accurate quotePlease Watch the video I explain why Drains .

Jonathan S. Jacobs, MD, DMD · Answer

Thank you for your question. Drains can avoid the development of fluid accumulation post operatively. These are common in abdominoplasty (tummy tucks) and breast reductions, though they are not commonly used in liposuction. They should be viewed at as safety device to help avoid post operative issues. Best of luck!

Camille Cash, MD · Answer

Drains are used to collect fluids during the healing process.  They are typically in for 1-2 weeks following surgery, although that varies by patient.  They are occasionally mildly uncomfortable and do require minor care (emptying, etc).  Most patients do vary well with them.  When not used there is a chance that the fluid typically removed by the drains will collect in a pocket and need to be aspirated.

Tom J. Pousti, MD · Answer

You are correct: different plastic surgeons to things differently. Each plastic surgeon may have his/her "opinion" that is based on their specific/unique education, experience, and personal preferences. Their opinions may also be shaped by unfavorable results they have encountered in their practices.   It is certainly possible to undergo tummy tuck surgery without the use of drains.  The "no drain" tummy tuck surgery has become more frequently performed as use of progressive tension sutures (using sutures to close off the space between the abdominal wall skin and the underlying muscle) has increased in popularity.
Keep in mind, that careful selection of your plastic surgeon will be the most important decision you make. I would not suggest that you select a plastic surgeon based on the criteria of: drains or no drains technique utilized.  Instead, I would make sure that your selected plastic surgeon is a board-certified plastic surgeon who can demonstrate lots of examples of achieving the types of outcomes you will be pleased with. 
I hope this helps.  Best wishes.

Anh Lee, MD, FACS · Answer

The use of drains is a matter of preference between surgeons.  Drains are commonly placed to help get out fluid or blood so that it does not accumulate which can cause pain or infection.  There is also a product called tissue glue that can be used instead of drains.  It would be best to ask your PS.  Best wishes!

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