Following any type of tummy tuck surgery, while you are healing and moving around and walking,the skin which has been surgically loosened normally moves against the deeper tissues while you heal.
It takes 1-2 weeks for the tissues to heal together and seal up the space between the tightened skin and the underlying tissues, This movement causes the collection of normal fluid in this space.
The fluid can form a collection called a seroma which often can be avoided by inserting drains at the time of operation or by suturing layers of stitches between the skin and the underlying tissues (quilting) When drains are inserted, you have to avoid showering, but usually can take ordinary tub baths and keeping your drains dry.
Quilting is effective for smaller tummy tucks, but I would recommend having drains for you. Consult your surgeon regarding this choice as your surgeon is best equipped to give you a detailed recommendation for your surgeon’s choice. (John M. Griffin, MD, Atlanta Plastic Surgeon)
Drains and Tummy Tucks
I have heard of some plastic surgeons not using drains. They have to do a bit more surgery in order to place enough stitches deep to try and close off the large space created in order to remove skin and tighten muscles. This may add to your surgical costs. Adding one or two drains lowers the risk of fluid collections while you are healing.
They may seem weird to have but they are easy to take care of at home. I have performed over 1000 tummy tucks without any major drain problems and a very low rate of fluid formation. (Robert J. Spies, MD, Paradise Valley Plastic Surgeon)
Safety of Drainless Tummy Tucks
Full Abdominoplasties (Tummy Tucks) are one of the bigger operations Plastic Surgeons perform for cosmetic reasons. It is common to place drains to prevent the collection of fluid under the skin that can occur after surgery.
Because drains are universally hated by all patients, techniques of internal suturing have been developed to possibly make drains unnecessary. Many Plastic Surgeons are now performing these procedures and are very satisfied with the results.
So, from that standpoint, these procedures are safe. However, if a patient develops a fluid collection (Seroma) after surgery, it needs to be drained, sometimes multiple times, and may persist for quite a while.
This complication does not happen very often. In my practice I have elected to use drains and have not had a late fluid accumulation for over 5 years and over 300 cases. I think both techniques are equally safe and give great results. (Donald W. Hause, MD, Sacramento Plastic Surgeon)
Drainless tummy tuck is safe
Drainless tummy tucks are safe. However, there is small chance of seroma with it. If that happens the drains might be required after surgery to treat it. Chances are small but not zero. (Vasdev Rai, MD, Dallas Plastic Surgeon)
Drains for Tummy Tuck
Both procedures are safe. Drains help to prevent seroma or fluid collections from building up under the skin after surgery. Patients tolerate drains very well. It is more important to choose the procedure and surgeon correct for you then whether a drain is used or not. (Lisa M. DiFrancesco, MD, Atlanta Plastic Surgeon)
Drainless tummy tucks are safe when done by an experienced Board Certified plastic surgeon.
Are drainless Tummy Tucks Safe ?
Not to use drainage in the Tummy Tucks elevates the risks of fluid accumulation in the surgical area. And even using them there is a risk of developing “seroma” fluid accumulation.
Fluid accumulation makes a distortion of the surgical area and a secondary deformity of distension and retraction. I always use drainage for almost a week in all my tummy tucks procedures. (Adolfo Sesto, MD, Dominican Republic Plastic Surgeon)
Drain or no Drain for Abdominoplasty
Progressive tension sutures can lessen the need for a drain. As a general statement, though, a surgeon will almost never regret placing a drain, but may more frequently regret not placing one. (Mark D. Wigod, MD, Boise Plastic Surgeon)Drains or no drains with tummy tuck
Tummy tucks can be done with or without drains. With drains – I remove drains in 1-3 days and use a compression garment and a binder. Some surgeons leave drains in for weeks. Others stitch the under-surface of the skin to the muscle.
Some use drains and no garments. They all work – so choose a Board Certified Plastic Surgeon who seems the right one for you. (Elizabeth Morgan, MD, PhD, Atlanta Plastic Surgeon)
Drains versus no drains
Tummy Tuck require drains the majority of the time. I would advise against a drainless tummy tuck. There are plastic surgeons that do that. You can use AC suturing technique called progressive tension sutures to quilt the skin down to minimize but not eliminate a seroma.
I would be wary of drainless tummy tuck. I am of the opinion that it’s better to be proactive in managing a seroma than reactive after the seroma has occurred. (Earl Stephenson, Jr., MD, DDS, FACS, Atlanta Plastic Surgeon)The issue of drain is the least import for the final result
There is a lot concern about he drains and my patients always bring up this issue. We do not like use drains if it does not help the final result and decrease the risks. You should be comfortable knowing that your board certified plastic surgeon will use the best,safest and least painful technique without compromising result. (Kamran Khoobehi, MD, New Orleans Plastic Surgeon)
Drains vs. no drains with a Tummy Tuck, what are the differences?
Mostly it is surgeon preference. I my practice I use the “different suturing procedure” you mention (called progressive advancement) and a single drain for 7 days and have good success with that and have almost no seromas any more. (Ronald V. DeMars, MD, Portland Plastic Surgeon)Pros And Cons Of A Drainless Tummy Tuck
The advantage of not having a drain is the inconvenience and discomfort of it. The con is that you could still develop a seroma which could require several aspirations done in the office. Not everyone may be an ideal candidate for this approach.
Discuss this option with your plastic surgeon to see if they routinely perform it and if you are a good candidate. One of the most important aspects is your overall results in the end which is not drain dependent.
I suggest you consult with a board certified, ASAPS plastic surgeon when making important decisions such as these. (Brian Joseph, MD, Orlando Plastic Surgeon)
There are differing points of view on the use of drains with abdominoplasty. Those who don’t use drains use internal sutures between the muscle and fat to close off the space so that fluid can’t accumulate as easily.
This adds to OR time and cost and can leave temporary dimpling in the skin. The only real cons for having drains is that they can be a bit of a nuisance having to deal with them for the week or so that they are in place. (Don W. Griffin, MD, Nashville Plastic Surgeon)
The “drain less” TT is the quilted TT of layered sutures or “progressive tension suture” abdominoplasty designed by Dr Pollock. The issue is you need to fit into a strict criteria in my opinion to have this.
Plus the %s are now increasing of the occurrences of operative seromas. I am now using ARTISS thrombinogen/fibrin spray on closure and now us only 1 drain inferiorly. Thus ONLY in person examinations allow a definitive option for the TT you need. (Darryl J. Blinski, MD, Miami Plastic Surgeon)
Surgeons differ over aspects of technique of Tummytuck. Some advocate “drain less surgery” using quilting technique. There are pros and cons to this technique, cons including increased OR time and skin puckering. It should not cost more.
Be sure to consult with a board certified plastic surgeon to help guide you. (Robert M. Tornambe, MD, New York Plastic Surgeon)
In my practice I still use drains during tummy tucks, especially for larger skin removal patients or when liposuction is also performed. Though I perform quilting/progressive tension suture techniques I still place at a minimum one drain which is typically removed within a week and does not cause the patient much issue.
There is a balance between your body “sealing” itself after surgery and producing fluid into surgically created spaces. I think the risk/reward ratio still favors a drain over repeated aspirations in the office if a seroma develops. (Nelson Castillo, MD, Atlanta Plastic Surgeon)
I do not know of a study comparing the 2 techniques. I always use a drain and remove it in 4 to7 days once the out put is 30cc or less per 24 hours. (Robert Brueck, MD, Fort Myers Plastic Surgeon)
I almost always recommend a post-surgical drain for 1-2 weeks after surgery, primarily to avoid a seroma, or collection of fluid under the skin which may require additional surgery. There are new drain-less techniques in development, but they have not yet proven successful in the long run.
Utilizing additional sutures underneath the abdominal flap can lead to distorted results, and while some surgeons are recommending the use of a new adhesive, there have been no long-term research on the effectiveness of this approach. (Reps B. Sundin, MD, Washington DC Plastic Surgeon)
Drains are generally used when the space being opened up in surgery is large, and could fill with fluid after the procedure. Quilting sutures may help diminish the drainage, but you will never meet a surgeon that regretted placing a drain.
It can not hurt, and will only help expedite your healing. (David A. Lickstein, MD, Palm Beach Gardens Plastic Surgeon)
Drain vs drainless surgery
I think it just depends on the surgeon and the comfort of the patient. But I do agree that it should probably be the least of your concerns. There are advantages and disadvantages to both. (Kiran Polavarapu, MD, Fort Worth Plastic Surgeon)
Drains are not necessary for most abdominoplasties.
Drains are used at the discretion of the surgeon. I seldom use drains in abdominoplasty and has not been plagued by seromas. Pain pumps are of arguable effect so I don’t use those either. (Vincent N. Zubowicz, MD, Atlanta Plastic Surgeon)
No drains, no pain-pump abdominoplasty.
This is not really a “technique” per say. The use of a pain pump is completely optional. Some surgeons feel pain pumps are critical and others feel they are a waste of money. The no-drains issue is much more interesting.
The actual published “techniques” which limit drain usage typically refer to lipoabdominoplasties. This is a technique where the abdomen undergoes extensive liposuction prior to skin incision. The fat is removed from the deep abdomen above the belly button and from all the skin below the belly button.
This allows for easy movement of the abdominoplasty skin flap. Resection then preserves a tissue layer known as “Scarpas” layer which is though to contain a large network of lymphatics. The proposed advantage is a significant reduction in postoperative swelling and lymphatic leakage – hence, no drains.
Many surgeons, myself included, perform a variation of this technique using the liposuction cannula to free up the tissue (“discontinuous undermining”) which limits the amount of separation of nerves and blood vessels to the remaining skin.
I have found drains can be removed in 5-7 days with this technique and have experienced a very low seroma rate. (David Bogue, MD, Boca Raton Plastic Surgeon)
No drain/pain pump
I personally do not use pain pumps. I almost always will use a drain. It is the preference of the surgeon based on their experince and I really don’t think the recovery is affected one way or the other.
What is more important is how much of a tummy tuck do you need. (Robert Brueck, MD, Fort Myers Plastic Surgeon)
‘No Drains, No Pain Pump’ Abdominoplasty
I think it would be much more important for you to concentrate on finding a surgeon that gets good results. You might find an excellent surgeon that uses 2 drains and a pain pump, like one of my associates, and a technically very poor surgeon that uses no drain or pain pump.
See my point? Plastic surgery is an art and all you should care about is finding an excellent result done safely by a surgeon who cares. Let him worry about what technique works best for him. (Ronald V. DeMars, MD, Portland Plastic Surgeon)
The use of drains in Tummy tuck surgery is a surgeon preference issue as well as a patient selection issue. In general, massive weight loss patients are more prone to collect fluid after this surgery and they produce more fluid than other patients who have not had weight loss surgery previously.
Therefore it is advisable to have your surgery with drains in place, in order to reduce post-operative complications from continuous fluid collections that would require drainage procedures and infection risks. (Semira Bayati, MD, FACS, Orange County Plastic Surgeon)
Each plastic surgeon has different surgical technique and post-surgical protocol based on his/her experience and expertise. In addition, surgical technique should be tailored to each patient’s body. Based on my experience, patients who have lost lots of weights tend to “make” more fluid.
I would utilize drains. Please select your plastic surgeon carefully. Please make sure that your surgeon is board-certified by ABPS and has extensive experience in body contouring for massive weight loss patients. (Sugene Kim, MD, FACS, Houston Plastic Surgeon)
Drains or no drains with tummy tuck explained
A procedure developed about 20 years ago called the progressive tension suture (PTS) method was found to reduce the amount of fluid in the drains to the point that some surgeons have eliminated drains altogether. I have been using the technique for a long time and find that if there is enough fat removal with the tummy tuck, drains are still helpful but they can come out much sooner than without PTS.
It should not affect the cost. (Richard Baxter, MD, Seattle Plastic Surgeon)
Difference in tummy tuck/abdominoplasty results with or without drains
I have not seen a difference in the outcome when using drains or not. I recommend that you look at the results very carefully and When deciding which surgeon is correct for you. Their outcomes will be the best indicator of what you can expect.
In choosing a surgeon to perform tummy tuck / abdominoplasty, it’s vital that you select a surgeon who is certified by the American Board of Plastic Surgery and has extensive experience in body contouring. (Joubin Gabbay, MD, Los Angeles Plastic Surgeon)
Many different ways to perform an abdominoplasty not use drains.
If your surgeon can obliterate the dead space without drains the risk of seroma will be minimize. I personally like to use deep sutures in advance the tension so that I can close the skin with little if any tension. (Vincent N. Zubowicz, MD, Atlanta Plastic Surgeon)
Closing the abdominal wound in a tummy tuck
We know that we can get very good results using quilting sutures to decrease drainage with a tummy tuck. Using glue can be very expensive and has the additional risk of an allergic reaction. Although you have been offered alternatives, I would ask your doctor to make the decision which may be best for you. (Ira H. Rex lll, MD, Fall River Plastic Surgeon)