Tummy Tuck Without Drainage Vs. with Drains?

Traditionally, surgeons have used drains after a tummy tuck to drain any fluid which may accumulate under the skin which has been repositioned and tightened.  We refer to this space beneath the skin as "dead space".  Basically a space without purpose, but one in which fluid can accumulate.  This fluid is usually serous fluid (clear fluid) from the disruption of the lymphatic vessels during surgery and not blood. 

Now, if the dead space is eliminated through quilt suturing of the skin which has been repositioned to the tissue underneath, there would be no place for the fluid to accumulate.  This suturing technique of the two layers to obliterate the dead space takes a bit more time in the operating room, but it works quite nicely and avoids fluid collection.  It works in both massive weight-loss patients and those who have not had significant weight changes other than pregnancy.  Not having drains brings a significant amount of comfort to the patient in exchange for a few minutes of longer surgery time.

Whether drains are used or not, there is a certain degree of swelling associated with a tummy tuck that results from a) disruption of the lymphatic vessels and b) from change in the pattern of blood flow to that part of the abdomen.  Swelling is related to fluid accumulation between the cells in the tissues and not in the dead space where the drains are placed or where the space is closed by sutures.  In conclusion, I have not found that having or not having drains makes a difference in the post-operative swelling. However, not having drains after the surgery is much more comfortable for the patient.

Tummy tucks are extremely common as patients often want to
restore their body to their pre-pregnancy state. There are several things that have made tummy
tuck recovery much easier for patients.



One of the biggest advancements is that there are new
techniques that allow your plastic surgeon to do a tummy tuck and not have to
use drains. The technique is called
progressive tension sutures. The sutures
help secure the abdominal flap that is advanced down during your tummy tuck in
position. By placing these sutures
surgeons can often avoid the need for drains.
This eliminates the area for the fluid to collect and your body can
natural absorb what little fluid is produced as it typically does in your daily
life.



Recovery from a tummy tuck is much easier without the drains
as patients are able to walk after surgery without the worry of the drains
being pulled on. It also avoids the pain
and discomfort associated with the drains as they can irritate the skin where
they exit the abdomen.



Please discuss your tummy tuck options with you plastic
surgeon.

Dear myfatbelly,

The use of drains during a tummy tuck procedure is a topic of discussion among plastic surgeons, and both approaches have their advantages and considerations.

Tummy tucks with drains involve the placement of small tubes to remove excess fluid that accumulates during the healing process. These drains help prevent fluid buildup, reduce the risk of seroma formation (pockets of fluid), and promote faster healing. However, some patients find drains uncomfortable and may experience limitations in their mobility and daily activities during the initial recovery period.

On the other hand, tummy tucks performed without drains rely on techniques such as progressive tension sutures or tissue adhesives to minimize fluid accumulation. While this approach eliminates the need for drains and may offer a more comfortable recovery experience for some patients, there is a potential risk of increased swelling due to the absence of drainage.

I must emphasize that I do not recommend drainless tummy tucks at all because they often lead to significant fluid accumulation that may require drainage with a needle postoperatively. This can be more painful and inconvenient for the patient compared to using drains during the initial recovery phase.

The difference in swelling between tummy tucks with and without drains may vary depending on individual factors such as surgical technique, patient anatomy, and postoperative care. While some patients may experience less swelling with drains, others may achieve comparable results without them.

Ultimately, the decision to use drains during a tummy tuck procedure depends on various factors, including the surgeon's preference, the patient's anatomy, and the anticipated extent of surgery. Both approaches aim to ensure optimal outcomes while minimizing complications and discomfort during the recovery process.

If you're considering a tummy tuck, I recommend discussing the option of drains with your plastic surgeon. They can provide personalized recommendations based on your specific needs and goals, helping you make an informed decision that aligns with your preferences and expectations.

Best wishes for your tummy tuck journey.

Sincerely,

Dr. Katzen
Plastic Surgeon

In my experience with Tissue Glu, there is less swelling due to the firm adhesion of the tissue surfaces with Tissue Glu.  The lack of a drain greatly eases recovery.

Thank you for your question.  Drains are placed during tummy tuck surgery to prevent seroma, or fluid collection, in the area in which the operation has occurred.  While the operation can be successfully performed without the use of drains, the risk of persistent seroma remains significantly higher in these cases.  It is my personal feeling as a surgeon that this risk outweighs any potential (relatively brief) inconvenience that drains may create.

Thank you for your question. A No Drain Tummy Tuck is usually an option. Surgical drains are awkward, irritating and very uncomfortable. They are always a worrisome part of abdominoplasty surgery for patients and produces lots of anxiety in patients. One reason that surgical drains are such a nuisance is that they make normal, everyday activities extremely difficult to perform such as: One reason that surgical drains are such a nuisance is that they make normal, everyday activities extremely difficult to perform such as: getting dressed, walking and showering. This can result into a longer recovery process. Another thing that patients worry about is the pain associated with pulling the drainage tubes out; drains are generally used in surgery to stop fluid from accumulating between tissue planes.

During a tummy tuck surgery, there is space between the abdominal wall and the overlying fat and skin (the abdominal flap). The body will do what it usually does during the healing process, produce fluid, if nothing is done to close this space. Because there is nothing to confine the fluid from accumulating, a seroma can develop in this space. In other words, the tissue produces fluid more quickly than it can reabsorb.

Negative suction drains are placed in spaces like this to get rid of the fluid and create suction between the tissue planes. There is a way, however, to eliminate this space without using uncomfortable drainage tubes. Utilizing progressive tension sutures inside the tissues to close off the space and relieve tension on the last surgical closure. This results into less pain, less discomfort and less tension. Also, there will be better scarring with potentially minimizes infection risk.

We have successfully used progressive tension sutures during abdominoplasty instead of surgical drains, with a lower seroma rate than is generally thought to occur with tummy tucks and drains. With this method, the seroma rate is close to zero and you cannot beat that approach.Dhaval M. Patel Double board certified Plastic surgeon Hoffman Estates Barrington Oakbrook Chicago 

I use a "no drain" technique in every Tummy Tuck and Body Lift procedure I perform, although if I also perform a significant amount of liposuction, I will commonly use a drain. "No drain" technique includes using what are called "quilting sutures" or "progressive tension sutures" that help close off spaces where fluid may collect and take tension off of the closure line of the skin.Your question about whether there is less swelling when a drain is places is a good one. I believe that drains can reduce the amount of swelling seen, but this is hard to accurately anticipate for a given patient. Surgeons that do not place drains undoubtably will see some fluid collections (called "seromas"), and in such cases, perhaps the use of a drain would have prevented this. My approach is to use quilting sutures in every case and to selectively use drains when I have performed a significant amount of liposuction -- a bit of a "belt and suspenders" approach that has made the occurrence of seromas drop to nearly zero in my practice.Hope this helps,Nick Slenkovich, MD

Drains vs No Drain Tummy TuckPlastic surgeon performing tummy tucks for more
than half a century years have used drains. Recently a technique has been
slowly becoming more popular using Progressive Tension Sutures (quilting
stitches) to attach the superficial skin/fat to the deep muscle layer
below to prevent fluid accumulation that a drain would otherwise
remove. It is not fool proof (nothing is), takes a bit more time under
anesthesia to place these stitches and a girdle is generally worn immediately
but a drain-less Tummy Tuck 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.For those patients who choose another surgeon,
the question to drain or not to drain
is at the surgeon's discretion. There is no consensus at this point though most
surgeons still favor drains until the output is generally about 30cc/24 hours. I
individualize and if little or no liposuction at the time of a tummy tuck, a
minimal or mini-tummy tuck I often do not use drains, whereas for significant
liposuction with a tummy tuck and other procedures (#MommyMakeover) I most
often use drains but individualize as needed.#DrainlessTT

I have not noticed a difference in post op swelling since changing from performing tummy tucks with drains and using the No Drain Tummy Tuck procedure.  It takes an extra 20 min in the operating room to place the progressive tension sutures which allow for closure without drains, but the added time in the operating room is well worth it. At our surgery center, we transitioned to the No Drain Tummy Tuck technique a bit more than 3 years ago and have had great success with it.  Most of our patients have liposuction at the same time as well. As a matter of fact, I'm currently collecting data on more than 400 patients who had both types of tummy tucks and the no drain tummy tuck appears to have less complications, including seromas, in our preliminary data.  In addition, not having the drains for 1-2 weeks is extremely nice for the patient, as they were the source of most of the complaints of tummy tuck patients back the drain era. 

Progressive tension sutures use absorbable sutures that close any cavities inside your body that are created after tissue removal, minimizing the risk of seroma/hematoma and making drains unnecessary. It can reduce the risk of infection and your recovery tends to be faster than if drains were used. However, thinner patients may require drains. That's why you have to get a consultation to see which technique would be best for you.