1 week post full TT with lipo. Binder garment causing pain, and not doing much for swelling. Do I need to wear it?

It sounds like you need to adjust your binder, or call your surgeon, and see if a girdle of some sort may be used instead.

I ask my patients to wear an abdominal binder to compress the space between their recently elevated skin and the underlying muscle wall. If the space is compressed and the friction between skin and the underlying tissues is reduced, then swelling and potential serum cavities are reduced. A similar principle applies with liposuction. Liposuction causes many internal pockets where the fat has been suctioned out. It looks like honeycomb. The garment compresses the pockets to limit fluid accumulation. I would strongly recommend you continue wearing your garment at least until your drains come out. You also have the option of changing the type of garment- perhaps a bike pant would be more comfortable? Lastly, the garment should be firm and not tight. 

Good question, but one that should be directed to your surgeon, not to a doc who has never seen you. If the garment is digging into your sides, it may not be properly fitting, and a different binder may be in order. All the best.