Thoughts on tissue glue vs. drains: which is best for my tummy tuck? (Photo)

Hi,Thank you for your question and photos.I'm afraid drains are a necessary evil when it comes to minimizing seromas in TT surgery. Yes, they're uncomfortable, but I believe them to be necessary. Quilting the tissues below has also proven to help minimize incidence in seroma formation. Take it easy and good luck in your upcoming surgery.Happy healing!

The purpose of applying #drains to a tummy tuck is to release extra fluid that may otherwise accumulate under the skin, fat or muscle following a surgery. 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. Also, a newer option now can include the use of tissue #glue to adhere the a#bdominal #skin to the #muscle; eliminating any space that previously required a drain.If you go to a plastic #surgeon who uses drains, or if your situation requires drains, they usually stay in 3-5 days but may be required to remain in longer. The most important decision to be made before performing any surgical procedure is determining whether you are an ideal #candidate. Your board-certified plastic surgeon will recommend the type best suited for you during a one-on-one in-person consultation. Also, another element to a satisfying result of your procedures are realistic #expectations.

I have used the tissue glue, which I think is great on delicate skin of the face but not so much the abdomen.  I also routinely "quilt" the skin down to the abdominal wall to limit fluid and blood from collecting.  Everybody then gets an ultrasound at each of my office visits. Guess what ? fluid still builds up as can be seen on ultrasound.  So I do use drains, but for a shorter period of time 4 -6 days usually, never more than 10.  I want the skin to perfectly stick down to the newly sculpted abdominal wall and fluid ca interfere with that.

Since your surgeon has assessed you in person, I would trust his or her recommendation. However, one of the risks with any new glue would be a possible allergic reaction so keep that in mind. My best,
Dr. Sheila Nazarian
@drsheilanazarian on Instagram

We know that we can get very good results using quilting sutures to decrease drainage with a tummy tuck. Using glue can be very expensive and has the additional risk of an allergic reaction. Although you have been offered alternatives, I would ask your doctor to make the decision which may be best for you.

 From the looks of your pictures it appears that you would do very well without drains. I think that there is always a risk of seroma but with the use of internal quilting sutures I have found this to be a very low incidence. If your surgeon suggested using tissue glue  or sealant along with internal sutures I think you will do great and do not necessarily need the drains.Good luck! 

Having used both progressive tension (quilting) sutures and tissue glue, my preference is for the former.  Although the sutures take a little longer to place, they seem to be more reliable than the glue.  I still use one drain to help prevent seroma formation but the sutures decrease the amount of time required for the drain to remain in place.  Speak with your plastic surgeon about which technique he/she prefers and your options.  Best wishes!

I have tried various techniques to eliminate drains after abdominoplasty but I still believe the safest way to do the procedure is to use drains.  By using drains I very rarely encounter a seroma in a post op patient.  Hope this helps.

I understand it's a misunderstanding tissue Glue does not replace currently the drain,even if the recovery is better using tissue glue. the most important thing is to always choose a certified surgeon

Having used the no drain progressive tension suture technique for a number of years now, the results speak for themselves. Drains do not prevent fluid or blood collections, and the data has shown that this technique has a lower incidence of fluid collection than the older technique using drains. I have not used the tissue glue, although I am familiar with it. Because the tissues can't be "progressively tensioned" using glue as with the suture technique, it would not have some of the advantages, such as improved scarring.

Sincerely,
Thomas C. Wiener, MD

this information is not a substitute for a consultation with a board certified plastic surgeon.