Drains vs no drains, massage vs no massage, compression garment vs no garment. What is right?

I see posts that all Dr's are different on the issues of drains, messages and compression garments, why is this? I want to know why some Dr's advise it and some do not.

Doctor Answers 12

Drains and tummy tucks

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I have always tried to stay ahead of the curve on new developments. We seldom use drains in typical tummy tuck surgeries any more. We have not had even one post-operative fluid collection (seroma) since we stopped using drains in 2013. I was anxious to try this technique initially because it seemed that most of my patients complained about the drains causing pain and making movement more difficult. Given that the number one cause of serious complication after tummy tuck is blood clots, I am very pleased to do whatever I can to get my patients up and around sooner and more frequently. I usually place an abdominal compression garment on to my patients 24 hours after surgery so as to avoid compressing the blood vessels that keep the new abdomen alive and well in those critical first 24 hours.  Lastly, we always counsel our patients on the need to avoid constipation after surgery. it is very easy to become painfully constipated when you are taking narcotic pain medications after surgery because those very same medications that decrease your pain, also slow down your gut. Couple that with the fact that it is more difficult to bear down with your abdominal wall musculature and a patient can quickly become very uncomfortable. Therefore, avoidance of constipation is also very important. Thank you for your question and good luck!

Drains and Tummy Tucks

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Thank you for your post. Whenever there is a potential space in your body, your body tends to fill that space with serous fluid (the yellow type of fluid that also comes out of a 'weeping wound'. This is similar to when you get a blister: the layers of skin separate and fluid is deposited in to the space. In a tummy tuck, the space is in between the skin/fat layer and the muscle layer. Most surgeons will place a drain to remove this fluid while your body is secreting it until the fat layer grows back together with the muscle layer. At that point, no more fluid is secreted into the area, because there is no more space for fluid. The length of time that this takes varies from patient to patient. Some patients heal much faster, thus the layers seal together much faster. Also, the more twisting motion you have in your belly area, the slower the two layers grow back together because they are moving in relation to each other. The fluid coming through the drain can be initially dark red, and eventually clears to pink then yellow. This is because it takes just a little bit of blood to make the fluid dark red. Also, initially, there can be a large amount of fluid (few hundred cc's in the first day is not out of the range of normal) and this should slow down substantially over next few days. Once the fluid slows down to the amount that your surgeon is comfortable with (usually 25-50 cc in 24 hours) then they will be pulled. There is minimal discomfort in pulling the drain in most patients.
More recently, 'drain free' surgery has become more popular. Fat layer is sutured down to the muscle layer starting at the ribs and progressively down to the lower incision. This makes the space for the fluid to collect much smaller, and in many patients can have surgery without drains. However, I have seen multiple patients come from other surgeons because they developed a seroma despite the suturing of the tissue. This is not the surgeon's fault, but some patients just do not heal fast enough or put out too much fluid for the body to absorb.
Best wishes,
Pablo Prichard, MD

Pablo Prichard, MD
Phoenix Plastic Surgeon
4.9 out of 5 stars 42 reviews

Drains, lymphatic drainage and garment post-abdominoplasty; protocol at Toronto Visage Clinics

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Thank you for your question.  Many philosophies and protocols exist for #tummytucks.  Over 12 years of practice, my protocol has evolved into using drains for several days even when using quilting sutures.  I have not had one single seromas over the last 6-7 years.  I recommend compression garment for 4 weeks and I do believe - as the Brazilians do! - in lymphatic drainage starting week 2 or 3 - minimum of 3-6 sessions.  

Hope this helps!  Dr. Marc DuPere, board-certified #plasticsurgeon, #Toronto, voted TOP plastic surgeon in Toronto for 2013 by Consumers.

Marc DuPéré, MD
Toronto Plastic Surgeon
4.8 out of 5 stars 71 reviews

Drains, compression???

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I assume you are asking about tummy tucks,  in regard to drains and compression.
Frist, it  is important to understand there is more than one approach tothis suregery referred to as an abdominoplasty or tummy tuck.   Scientific data is the basis for surgical choices....but this is influenced by the surgeons training and experience.   There no single "right answer" and it is the surgeons responsibility to chose the safest and most effective operation..
As to your specific questions,  drains have been traditionally used with TT  to prevent fluid accumualtion,  we have described (2000) a technique that use stitiches to advance and anchor the abdominal skin flap to the underlying tissues, which eliminates the need for drains. (progressive tension sutures.or PTS)   We published a series  nearly 600 cases (2012) using PTS that proves that drains are unnecessary when PTS are used. (1 small fluid accumulation in 597 cases).  of course, drains can be used with PTS,  but we don't in our practice.
Compression garments are used by most surgeons to minimize swelling and bruising, but also (prob. more important) to provide support for comfort when muscle repair is done.
Most important is consultations with one or more surgeons certified by the Am. Bd. of Plastic Surgery.   The technique used is the surgeon's prerogative and responsibility.

Harlan Pollock, MD
Dallas Plastic Surgeon

So many questions about tumy tucks.

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It is easy to be confused about post op care because there are so many ways to "skin a cat".  Each doctor may do the procedure a bit differently, and then, each may have preferences as to post op regiment.  Many times there is no "right or wrong" answer. 

What is important I think, is that you settle on a board certified plastic surgeon whose work you like and ask the doctor what the regiment is, and why it is done that way.  The doctor should be able to give you a concise answer.
What works best for me is drains until the 24 hour total is low, and a binder after about 5 days when the circulations is assured.  I don't do "massage" for tt.  It is also important to remember that individual cases may require a change in protocol.

Abdominoplatsy differences

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Drains/no drains differences are most likely related to closure techniques. I use to utilize drains routinely with abdominoplasties but since I started using progressive tension sutures as part of my closure I have not used drains and have had only minimal issues with post op fluid collections.  The progressive tension sutures in part help to obliterate the space where fluid can accumulate under the flap postoperatively thus making the drains unnecessary.
I still use compression garments routinely on all patients where the potential for fluid to accumulate exists.
In my opinion scar massage expedites and facilitates the healing process but in patients who feel uncomfortable doing so i say they they will get the same result only it will take longer.

Paul Buhrer, MD
Annapolis Plastic Surgeon

Drains, Massage, Garments???

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There are many ways to get a good result and every surgeon and patient may need a different course of action. In general, drains may be necessary for a tummy tuck or breast reconstruction. Massage may be an acceptable practice after breast augmentation and compression garments are worn after liposuction and abdominoplasty.

Consult a Board Certified Plastic Surgeon.

Best wishes

George C. Peck, Jr, MD
West Orange Plastic Surgeon
4.8 out of 5 stars 25 reviews

To drain or not to drain

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Thank you for you question as you have probably heard various answers to this question if you have seen several plastic surgeons already for a consultation.  

First of all in my opinion their is not correct answer to this question.  Whether or not to use drains has to be evaluated in the context of the surgery as a whole and your particular situation.  

In my practice I typically do not use drains for a routine abdominoplasty.  The technique of progressive tension sutures, allows the abdominal flap to be secured to the abdominal wall and thus decreasing the potential space for seroma formation.  

I switched from using drains to the progressive tension method with out drains mostly for patient comfort.  The drains were always my patients biggest complaint following surgery.  Since I have stopped using them they have been much more comfortable.  

I hope this helps.  

Recommendations for drains, compression garments and massage

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There is a tongue-in-cheek saying that if you ask ten plastic surgeon for an opinion, you will get twelve different answers.  None of them is necessarily right or wrong.  Each of us uses our training and experience to formulate a plan and process so that we achieve good outcomes for our patients.

In my practice, I do not use drains since I started putting quilting sutures  in tummy tucks.  My patients are put in soft compression garments just to help control swelling.  Most patients prefer the garments and tend to wear them for several months, but I do not think they are necessary.  Massage seems to help minimize the 'lumps' that can occur after liposuction, but again, it is not mandatory.

Hope this is helpful.

Michael S. Hopkins, MD (retired)
Albuquerque Plastic Surgeon

Different post op routines for the same tummy tuck ?

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Your right,  We as plastic surgeons all have different routines for post op management. There is really no right or wrong answer. Many of the differences are a matter of style.

Most docs leave drains as a safety precaution, while some are trying to quilt the abdomen and avoid them completely. I don't think anyone would object to massage but many find it unnecessary.

In my own practice drains or not will depend on the size of the patient and the extent of the surgery. I don't generally recommend massage but I have no objection to it after an appropriate healing time.  I am a big fan of Spanx for post operative compression.

I think the key is to like and respect the surgeon you choose. Minor variations in post operative management will likely make little difference.

Best wishes.

Adam Tattelbaum, MD
Washington DC Plastic Surgeon
5.0 out of 5 stars 115 reviews

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.