Drainless tummy tuck vs. with drains: what's the difference and which one is better?

I think that you have to leave your surgeon with the option to use a drain if he or she feels that it is necessary during the surgery. In most cases I have now stopped using a drain and I do stitch the abdominal flap down to the muscles underneath. This obliterates the space where the fluid can collect and I think that it also prevents the skin flap moving over the underlying muscles and facilitates the flap sticking down to the muscles. I have been very pleased with this approach and I believe that my seroma rate is lower even without drains using this technique.

In order to avoid using a drain during a tummy tuck, a surgeon generally places multiple rows of deep resorbable sutures under the skin, which act to eliminate any dead space and prevent shearing forces between the abdominal wall and the skin flap. This decreases the chance of developing a fluid collection (seroma) after surgery and makes drains unnecessary.  In my opinion, the pros vastly outweigh the cons and I generally perform only "drainless" tummy tucks. I also routinely perform extensive liposuction at the same time as the tummy tuck.Pros
+ increased patient comfort/convenience from having no drain after surgery
+ decreased rates of seroma
+ less tension on abdominal skin closure, which may result in better scars long term
Cons
+ takes a bit longer in the operating room
Emile N. Brown, MD
Board Certified Plastic Surgeon, Johns Hopkins & Harvard Trained

I believe it can safely/effectively be done either way, and selectively use drains myself, especially if a patient is heavier (with more potential for fatty oozing), is having hip/flank liposuction concurrently (2/3 of the time), and especially if their risk factors for a blood clot (increased BMI, age, time on table, positive family history) require that we add Xarelto to their post-op regimen, which may cause some oozing. Usually a single lower abdominal drain is in place only 5-7 days, and doesn't cause a lot of headaches/discomfort, but it sounds like you're in better shape if you don't need adjuvant liposuction and therefore are a candidate for a drain-free approach (and we rarely see seromas that require further intervention in those cases . . . )  Hope this helped!