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

A tummy tuck can be done without drains.  The upper abdomen is quilted down to the abdominal wall to help prevent fluid accumulation.  This can leave temporary indentations in the skin in thin patients.  Unfortunately many patients still accumulate fluid that then needs to be drained in clinic after the surgery.  By having a temporary drain you can avoid having a secondary procedure to drain the potentially accumulated fluid.  I typically will use drains to avoid that potential discomfort and problem.  

Abdominoplasty procedures have been done with drains for many years with good results. If his surgeon has experienced doing this procedure, the drains are more of a short-term nuisance than anything. They usually are removed within the first week or 2 and in the hands of a skilled surgeon good abdominal contour can be achieved with this method.
Drainless abdominoplasty is also a safe and effective procedure. A series of sutures are placed between the skin and the abdominal wall muscles in order to pull the abdominal skin down and prevent a large pocket of empty space between the abdominal wall and abdominal fat/skin layer. Because the space between these 2 structures is closed off by sutures, there is no space for a drain and we have found that drains are not needed in many patients. Placing the sutures usually adds between 15 and 30 minutes to the length of the surgery.
Overall,I would not say that one procedure is better. Finding a well trained Board certified or board eligible plastic surgeon who is comfortable with the procedure and is honest about expectations is most important. Whether they perform the abdominoplasty using drains or without drains is not likely as important in determining your overall result.

Dear MommySAVan,
every plastic surgeon has his preferred technique. Some use drains others don't. Drains are a good option when you expect fluid accumulation so it prevents seroma formation. If you are considering a surgery, I would suggest you to consult a board-certified plastic surgeon. Only after a thorough examination you will get more information and recommendations.
Daniel Barrett, MD

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!

Thanks so much for your question, it's one that we are hearing from patients more often with the growing popularity of the "drainless" tummy tuck. 
The "drainless" tummy tuck describes the method of closing the skin and soft tissue at the end of the procedure. By using progressive tension/quilting sutures or tissue adhesives, it’s possible to minimize the body’s natural production and accumulation of protein fluid at the surgical area. Less fluid means less need for any postoperative drains, and many patients report increased postoperative comfort, increased level of activity, and a quicker recovery and return to their daily activities. 

As far as which procedure is "better", talk to you Plastic Surgeon about whichever method he or she is most comfortable performing for a tummy tuck, since that technique is the one that should provide you with the best result. 
I hope this is helpful, best of luck with your procedure and recovery!
Peter A. Felice, MD

Hello and thank you for your question.
There are several ways to do a tummy tuck and every plastic surgeon likely does it slightly differently. When I perform a tummy tuck I do not use drains and I have been extremely happy with the results. I use a technique called progressive tension sutures in which I place sutures to hold the abdominal skin in place and help close the space to minimize any chance for fluid to collect. Whatever fluid your body makes during the recovery period is safely reabsorbed by your body. Suturing the abdominal skin also helps distribute the tension across the belly and it minimizes the tension at the lower incision, which can help produce better scars.
The no drain tummy tuck makes recovery much easier for my patients. Without the drains, patients are able to walk after surgery without the worry of the drains being pulled on and it avoids any pain or discomfort associated with the drains at the skin where they exit. Another technique I use during my tummy tuck is injection of Exparel, which is a long lasting local anesthetic that I place along the muscles that are tightened to help with pain relief during the recovery process.
I recommend you consult with a board-eligible or board-certified plastic surgeon who specializes in aesthetic plastic surgery. Make sure they discuss all your concerns including the risks, benefits, recovery, and postoperative course. 
I believe a key component of the consultation is to establish a good connection with your plastic surgeon. If you don’t feel like you have a good connection then they may not be the best surgeon for you.
Good luck!
Olivier A. Deigni, MD, MPH
Houston Plastic Surgeon

Hello,
Thank you for your inquiry. To give you the most valid medical opinion pictures of your area of concern are necessary. However, in our practice we do a variety of absominoplasty's - some with and some without drains. If you are receiving no lipo I would opt for a 'no-drain' abdominoplasty There are pro's and con's to using vs. not using drains.Using Drain Pro's/ Progressive Suture Cons- Takes less surgical time (shorter time under GA for the patient) - Clinically, decreases the chance of seroma (especially if copious amounts of liposuction is done at the same time) Using Drain Con's/ Progressive Suture Pros - Increased chance of infection using drains - Decreased patient comfort and convenience having drains in post operatively - By using progressive suturing, and eliminating dead space, you can prevent seromas as well as take tension off of the incision line 
We encourage you check out our website and instagram (drkaraplasticsurgery) for lots of before and after pictures!
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M.Kara,MD,FRCSC (27+ years of experience) 
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There is basically no downside to using a drain and a small downside, called a seroma, to not using a drain. Therefore at our facility we perform the so-called "drainless" TT with progressive advancement sutures but always use a drain for a few days. In every case we get 200ccs and sometimes more fluid out in the first few days. If you didn't have a drain and the body absorbed the fluid, you would never know that had happened. But on the occassional time when the body did not absorb the fluid, it could cause a seroma which can lead to an internal scar contraction that would alter the good results we achieve in a bad way, and possibly require more surgery.