What is the clinical indication for a TT with drains vs without drains?

What is the clinical indication for a TT with drains vs without drains? Is there evidence based research to support one more than the other? Does one have better outcomes?

Doctor Answers 13

Indications for TT With or Without Drains?

As far as I am aware, there are no good predictive studies which compare outcomes for patients who did or did not have drains when having a tummy tuck. So no, there is no evidence to support that one approach as being better than the other. As others have indicated, it very often comes down to physician preference.

There are studies that show that a tummy tuck can be performed without a drain by using a technique called Progressive Tension Sutures with a relatively low incidence of post-operative seroma. Surgeons use drains to prevent seromas, but even when drains are used, it is still possible to develop a seroma after the drain is removed.

Drains are very annoying and inconvenient, and once patients have gotten past the initial post-op pain from the surgery they are usually the thing that patients complain about most. So it makes some sense that eliminating the drain would make the recovery process a little less unpleasant. The problem however is that if the patient develops a seroma because they didn't have a drain, then they will need to return to the surgeons office regularly and frequently to have the seroma aspirated with needle and syringe until the seroma is gone. This can sometimes go on for several weeks and sometimes the repeated needle aspirations are not successful in resolving the seroma. This results in something called a chronic bursa which requires surgical revision to repair. So if you do develop a long lasting seroma or chronic bursa this will definitely have a negative impact on your outcome.

In my personal practice I take a sort of combined approach. I use the Progressive Tension Suture technique when closing the space that is created when the skin is undermined for a tummy tuck. I also use a drain, but in part because of the progressive tension sutures, the drain stays in for a shorter period of time. and when it is removed there is less chance of getting a secondary seroma. Some patients may decide to choose a certain surgeon based on whether or not they use a drain and I think that is mistake. One should really choose their surgeon based on education, training, Board Certification, reputation, experience, and clear demonstration of quality outcomes through photographs and patient reviews. Whether or not the surgeon uses a drain is really a minor consideration in the big picture of overall quality of care and excellent results.  

Drain or no drain with tummy tucks: the evidence

The drainless tummy tuck is based on the use of a technique called progressive Tension Sutures (PTS) which I have been doing for 20 years. The reason for using drains is to reduce fluid collections called seromas, and there are studies showing that the rate of seromas is low with the PTS technique. Personally I use both, because even with PTS there is fluid in the drains. As compared to no PTS, the drains can be removed much sooner.

Richard Baxter, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 48 reviews

Drains or no drains

Hello
When the skin is separated from the abdominal wall during the tummy tuck, it leaves a raw surface that can ooze blood and fluid until it sticks back down to the muscle. That blood and fluid could accumulate and cause what's called a seroma (a collection of fluid under the skin). For that reason, many surgeons use drains so that the fluid drains out, rather than accumulating under the skin. However, there are newer techniques that allow us to avoid drains in many tummy tucks. Some surgeons use "quilting sutures" or "progressive tension sutures" to stick the skin back down to the abdominal wall. This works very well to prevent fluid buildup, take tension off the incision, and reduce swelling. Some surgeons will use quilting sutures, but also place a drain for a short time. All of the above options are acceptable, drains or no drains, and will depend upon your surgeon's experience and preferences.
I hope that helps.
Best wishes-

Tummy tuck- drains or no drains?

Thank you for your question.The indication for drains in a tummy tuck mainly has to do with the technique used by the surgeon. Some surgeons utilize a technique known as progressive tension sutures to decrease the potential space between the subcutaneous tissue flap raised and the abdominal wall- in this case drains are not necessary. If progressive tension sutures are not used drains are used to provide an egress for fluid so that a fluid collection, or seroma, does not form underneath the skin flap. Both techniques work well and have plenty of evidence based research to back them. It really comes down to which technique your surgeon feels is right for you.Personally I prefer the progressive tension suture technique so that my patients don't have to bother with drains. Also, it offloads the tension so that a thin line scar can form. My best advice is to look at your surgeon's before and after photos to determine whether their skillset can meet your needs.Best wishes, Dr. Meghan Nadeau, Seattle, WA

Meghan Nadeau, MD
Seattle Plastic Surgeon
5.0 out of 5 stars 4 reviews

What is the clinical indication for a TT with drains vs without drains?

When performing a tummy tuck, a lot of empty space is created when lifting and redraping the abdominal skin/fat layer - this space tends to accumulate fluid, hence the use of drains traditionally.  Another way to address this issue is to close the superficial and deep layers of this empty space with multiple stitches, essentially closing this empty space and negating the need for drains.  Although this may appear clever, the multiple stitches that are tacked down to the fascia tend to contribute to increased postoperative pain and also lengthen the procedure.  Furthermore, modern day technologically advanced drains hardly contribute to any pain and are painless coming out.  As a plastic surgeon, If I were getting a tummy tuck, I would have it with the drains (my preference).  Be sure to consult with an experienced board certified plastic surgeon.  Good luck!

Zachary Farris, MD, FACS
Dallas Plastic Surgeon
5.0 out of 5 stars 16 reviews

TT Drains or not

The most common complication after an abdominoplasty is seroma formation- if you scrape your knee, the clear yellow fluid that comes out is tissue serum.  Now imagine an area all the way up to your rib cage lifted up under the skin and weaping this fluid until it becomes "glued back together" with the healing process.  If this collects it is a seroma.  Full healing may take 6 weeks.  I have been using progressive tension sutures for many years- they tack the deep tissues down and may decrease the risk of seroma formation.  So the drains may be able to come out sooner. I still like to use drains however and feel that the benefit outweighs the annoyance factor.  Most patients would prefer drains for 6-8 days to getting a seroma and requiring weekly visits to the office to have this drained.

Jonathan Hall, MD
Boston Plastic Surgeon
4.9 out of 5 stars 29 reviews

Tummy Tuck with drains vs without drains?

Drains are used to prevent a seroma or fluid accumulation under the flap. Progressive Tension Sutures, which I have used for many years, reduce the risk of seroma. If a patient gets a seroma, this can lead to weekly or more frequent visits to remove fluid with a needle and syringe, and if it persists, return to the operating room for drain insertion. Some surgeons do not use drains because the Progressive Tension Sutures reduces this risk. I do both...I use drains as well. Although a minor inconvenience for the 7-8 days they are in, they do evacuate a fair amount of fluid, and I think the drains reduce the risk of seroma even further. Since using both the PTS technique AND drains over the past many years, I have not had a patient with a seroma. 

What is the clinical indication for a TT with drains vs without drains?

This is purely surgeon preference.  Some do and some don't use drains.  The important consideration is the results a surgeon can deliver.  If they do a great job with drains and the patients have great results, then go with it.  If they do a poor job, then seek a qualified surgeon based on what they can deliver.  The duration of the drains is usually less than 10 days and will go by quickly.   I would start with a face to face consult with a Board Certified Plastic Surgeon who has experience in abdominoplasty (tummy tuck) surgery. During your visit your surgeon should be evaluating your health to determine if you are a good surgical candidate and examining your tissues to get a sense of what type of procedure your tissues will allow. Only with a hands on exam can this be determined. During the consult you and the surgeon should be understanding of the goals and realistic outcomes of your choices. Once an exam and opinion is rendered then you can decide if surgery is right for you. Good luck.

David J. Wages, MD
Peabody Plastic Surgeon
5.0 out of 5 stars 19 reviews

Tummy Tuck with Drains or Without Drains?

While the use of drains in a tummy  tuck or abdominoplasty is really a surgeon preference and has no effect on outcome, drains are a real nuisance and the one thing most patients hate about their abdominoplasty recovery.  For that reason, I have moved away from drains in all tummy tuck surgery.  Surprisingly, it has greatly improved tummy tuck recovery.  I have added a video and web reference for you.I hope that helps.Best regards.

Brian Windle, MD
Kirkland Plastic Surgeon
4.9 out of 5 stars 58 reviews

What is the clinical indication for a TT with drains vs without drains?

The only determining factor regarding whether to use drains is based on surgeon preference. A tummy tuck creates a large area for fluid to collect. I personally use drains to allow the fluid to come out, so that it doesn't collect under the skin.As long as your surgeon has good results with their technique, then I wouldn't hesitate to go either way whether they use drains are not.

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.