What is Your Opinion Regarding the 'No Drains, No Pain Pump' Abdominoplasty Technique?

I have been researching the different techniques used for abdominoplasty and would like to get the the opinion from a PS's point of view on the 'no drains, no pain pump' technique on a full TT? From what I've researched it has a much faster recovery time as well as minimal pain after surgery. Is this technique a proven one and how long have PS been performing it? Thank you.

Doctor Answers 14

No Drains, No Pain Pump Abdominoplasty

Both drains and pain pumps are optional in abdominoplasty. What an individual surgeon does is based on experience and personal preference. Both drains to suction the flap tight and hold it to the underlying tissues and placing multiple rows of sutures to hold the flap against the underlying tissue work well. It is my experience that both work well and have essentially the same type of problems. There is really no advantage of one over the other. I personally use drains as I have seen less fluid collections with using them and using the sutures lengthens the anesthetic time. Pain pumps have significant theoretical benefit, but I have found them more of an inconvenience than benefit. Almost all of my patients do well with minimal pain meds which they stop using in 2-3 days. The only other time of discomfort is in 5-8 days when you are walking bent over and your back starts aching. No pain pump will control this. All of these options are quite old, but there is a new topical anesthetic that can be put in the wound to control pain for several days.

Highlands Plastic Surgeon
5.0 out of 5 stars 6 reviews

Comments on the "No drains, no pain pump abdominoplasty technique."

First of all, describing use (or no use) of a drain and/or a pain pump as a "technique" is a bit of a stretch. For example, I use below-the-skin dissolving sutures on most of my surgical procedures, as it avoids crosshatch marks and the discomfort of suture removal.  I believe this type of closure yields a superior scar in most situations, which is why I choose to use it. This method of incision closure could be called a technique, but to describe my tummy tuck as the "No stitch abdominoplasty technique" would be disingenuous as well as incorrectly implying that this is somehow a bona fide distinguishing difference between my method of incision closure as compared to other plastic surgeons. I'd rather just tell my patients that I close all of my incisions really precisely and take pride in the good scars that this attention to detail yields, rather than describing it as a "technique" that makes it innately "superior" to all others!

The same applies to use of drains or pain pumps. I actually use a long-acting local anesthetic injection into the muscle sheath where I place my muscle-tightening sutures, as this helps reduce post-operative pain and muscle spasm from this standpoint. I also inject the incision areas, and when I use a drain, the drain exit site(s). Most of my patients have very little "pain," and use little narcotic medications, but then I also have careful surgical technique, and use anti-inflammatory and muscle relaxing medications for my patients in addition to simply covering the pain with narcotics.

Many surgeons use drains; others do not. To describe use as "bad" and non-use as "good" is meaningless--let's compare subjective patient pain responses post-op, return to activity and work status, and final cosmetic results. These are significantly more important than use of drains, pain pumps or not!

So choose your surgeon based on his/her results, and realize that those results are a culmination of training, experience, and prior patient outcomes, NOT a choice to use or not use a drain, pain pump, suture technique, or other such issue. I know patients worry about pain, some more than others, and that IS a very real and important concern. But a much more important one, IMHO, is whatever your chosen surgeon does to achieve the results you desire.

Two horns do not make a symphony. Neither do these two "techniques" make a fabulous result! Choose your surgeon based on results, not technique! Don't get me wrong--careful technique IS important, but in every step and component of a surgical procedure, not just two. Best wishes! Dr. Tholen

Richard H. Tholen, MD, FACS
Minneapolis Plastic Surgeon
4.9 out of 5 stars 254 reviews

Drain or no Drain with abdominoplasty surgery

There is no right or wrong answer to this question and every technique will not be correct on every patient.  The use of progressive tightening sutures has been well established and many plastic surgeons feel confident in not placing drains.  As far as a pain pump, also a personal decision.  In my opinion they help tremendously and help get my patients out of bed the night of surgery and walking around.  This will reduce the chances of DVT/PE.

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 19 reviews

No Drain Tummy Tuck

The No Drain Tummy Tuck has great results by surgeons who know how to do it. However, it is not the most important part of a tummy tuck. The Pain Pumps work well but there are other ways of reducing discomfort also. 

Karol A. Gutowski, MD, FACS
Chicago Plastic Surgeon
4.9 out of 5 stars 68 reviews

The no drain no pain tummy tuck

Tummy tuck without the use of drains has been our technique for ten years and running. Our patients do get up quicker and feel better. We also don't use pain pumps, and again the recovery experience is faster and more pleasant without. Proven yes, without a doubt.

Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 42 reviews

No drains no pumps in good hands is excellent technique/ no drenajes no bombas en buenas manos es exceelente tecnica

i have been doing it since  several years without any big  complication exception seroma, the secret it is in doing a good coagulation and coaptation trough several internal coapting sutures than selling both fascies, another  exception could be a big complete circumpherential TT

las excepciones  serian una completa TT circunferencial, y se forman algunas veces  seromas, el secreto  esta en hacer varios  nudos internos que sellan ambas fascias la profunda y la superficial

Ramon Navarro, MD
Mexico Plastic Surgeon
5.0 out of 5 stars 2 reviews

Exparel and progressive tension suture tummy tuck

The no drain technique uses progressive tension sutures (PTS) which close the space under the flap. It has been used by many plastic surgeons for at least 15 years. Exparel is a long acting numbing agent that can be used instead of a pain pump.

Richard Baxter, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 52 reviews

No drains, no pain pump tummy tuck

Many surgeons perform their tummy tucks with no drains, either by using quilting sutures or with tissue glues or sealants.  Quilting sutures can give an odd appearance with dimpling on the skin surface which can upset patients.  

Pain pumps reduce surgical pain by giving local numbing medicine into the area where the 'muscles' (fascia) are tightened, so why have surgery without the pain pump?

In our practice, use of these measures has decreased or eliminated the usage of drains for less invasive tummy tucks and for full tummy tucks alike.

In any event, as with everything else, 'times they are a changin'", with the patient benefiting!

Brent Moelleken, MD
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 177 reviews

No Drains, No Pain Pump, Tummy Tuck Surgery?

One of the  realities in the field of plastic surgery is that if you were to ask 10 plastic surgeons for their opinions, you would receive at least 11 different different  In(and ver any st androng/adamant)  opinions.  This is simply the nature of our  discipline.

 If you are looking to have tummy tuck surgery performed, I think you will be  best of spending your energy choosing the plastic surgeon who you feel can most likely achieve the results that you are looking for safely and consistently. The exact technique used, use of drains or not, use of pain pump or not etc. are not nearly as important considerations.

 Best wishes.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,484 reviews

Drains and Tummy Tucks

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
5.0 out of 5 stars 46 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.