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.

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.