No Drain Tummy Tuck – Reviews Of Plastic Surgeons
There is some difference of opinion among plastic surgeons regarding the use of drains. The advantage of drains is the prevention of fluid accumulation in the space created during the tummy tuck. It doesn’t guarantee total prevention of fluid.
The biggest disadvantage is that drains are annoying to most patients. I personally prefer to use drains and temporary compression with a stretchy abdominal binder. (Richard L. Zeff, MD, Portsmouth Plastic Surgeon)
Drains are placed at the time of tummy tuck surgery in order to prevent the accumulation of fluid between the skin of your abdomen and the underlying muscles, until the tissues heal back to one another.
Depending on the tummy tuck surgery performed, some surgeons use multiple drains, while others only use a single one. These are effective in removing fluid, but not 100% successful. Some physicians have moved towards not using drains, instead using stitches to sew down the skin to the muscle from the inside, thereby hoping to promote earlier healing and fluid buildup.
This too is safe, but not 100% successful. Surgeon adjust their drain technique based on the patient, so best to ask your surgeon their recommendations for you. (Nelson Castillo, MD, Atlanta Plastic Surgeon)
Both techniques are safe and are more a function of the comfort of the surgeon in doing without a drain. One can always be put in if needed or removed if not. (Frederic H. Corbin, MD, Los Angeles Plastic Surgeon)
New Study Shows Lower Complication Rate of Drainless Tummy Tuck
A recent study was reported at the 2016 ASAPS meeting which showed unequivocally the superiority of the drainless tummy tuck when performed by a surgeon experienced in this technique. The minimal additional time to perform the procedure was felt to be well worth the benefits, which included significantly reduced fluid collections (seromas), quicker recovery, and less patient discomfortI I hope that you find this answer helpful. (David F. Pratt, MD, Kirkland Plastic Surgeon)
No Need for Drains! The Research Study Confirms Drainless Tummy Tucks are Best!!!!
We have just completed a large study with over a hundred drain less Tummy tucks compared to over 300 drained tummy tucks and found that the ones without drains did as well as those with drains.
We no longer use drains at Marina Plastic Surgery for our tummy tucks and we have the research to prove that it works just fine. It adds 10 minutes but we still average 2 hours for the surgery.
It eliminates the haste of the drains, the pain of the drains and the pain of removing them and it eliminates the scars that they create. (Grant Stevens, MD, Los Angeles Plastic Surgeon)
Drainless tummy tuck is safe. If your surgeon has used the procedure and has sticked with it it has probably worked for him. Surgeons tend to do those things that have been reliable and predictable for them and many are not willing to change until clear benefits have been shown for a new or different technique. (John P. Stratis, MD, Harrisburg Plastic Surgeon)
I personally would not do a TT without drainage because of the risk of a seroma. Interestingly though, about 4 years ago I switched from using 2 rather large drains to using only 1 which is about the size of a piece of spaghetti and just slides out painlessly.
The seroma rate has gone to essentially zero with the new system and it is very well tolerated.
Don’t let the drain issue be the deciding point on where to have your tummy tuck done.
Go with the doctor who is going to give you the best looking result. (Richard P. Rand, MD, FACS, Seattle Plastic Surgeon)
Drains or drains in tummy tuck
Most surgeons will tell you that what they do is mostly due to how they are trained and what technique they use. I generally use drains when I do full tummy tuck and none when I do mini tummy tuck.
While most patients prefer not having to deal with the drains, they also would rather not have the seromas either. Also, a lot of my patients are from long distance away. Taking care of seromas (by repeated draining with needles and syringes) prove to be difficult to manage.
Therefore I prefer to use drain tubes for full tummy tuck. They are safe and easy to care for. (Neil T. Chen, MD, Albuquerque Plastic Surgeon)
You will find that each plastic surgeon has a different preference and treatment style with any surgery. There are surgeons who use 2 drains, 1 drain or no drains. Those who use no drains usually use “quilting” sutures that tack the skin and fat of the external belly to the muscle and fascia layer of the belly wall to prevent fluid accumulation (seroma) and thus to eliminate the need for a drain or multiple drains.
It is a little more time-consuming and not 100% effective, but neither are drains. Drains are also uncomfortable and generally patients hate them. So simply put, yes this is a safe procedure. with your surgery!. (Jeffrey A. Sweat, MD, Sacramento Plastic Surgeon)
Drainless Tummy Tuck Safe? Yes and No
Modern techniques of abdominoplasty use multiple quilting or progressive tension sutures to sew the flap back down to the abdominal muscles. This speeds the reattachment of the flap to the muscle and greatly reduces the drainage problems we used to see.
Some surgeons have taken this to the point of not using any drains in tummy tuck. If you do that about 10% of people will develop a fluid collection under the flap called a seroma. If that happens, you will need it drained by repeated needle aspiration.
It can become infected which may require widely opening the incision. I think it is much more prudent to leave a tiny drain in for a few days eliminate the risk of seroma. The drain does not hurt and comes out easily.
If someone says they never have a seroma, either they don’t do much surgery or they are not telling you the truth. Seek a plastic surgeon who is certified by the American Board of Plastic Surgery who specializes in cosmetic plastic surgery, as evidenced by membership in The American Society for Aesthetic Plastic Surgery.
Ask to see many pre and post op photos and speak with previous patients. (John Squires, MD, Denver Plastic Surgeon)
Safety of drainless tummy tucks?
I have done tummy tucks both ways: with drains, and drainless tummy tucks in which the space where the drains would be inserted is sewn closed (“progressive tension sutures” or “quilting sutures”). In my own experience, patients are very happy not to have drains, and I have not observed an increased incidence of fluid collections or other problems to date.
Surgeons can achieve good results both ways but my preference is to avoid drains when possible. (William Andrade, MD, Toronto Plastic Surgeon)
To drain or not to drain an abdominoplasty
It is usually up to the plastic surgeon to decide whether or not to use a drain. Both methods are safe. (Jeffrey Zwiren, MD, Atlanta Plastic Surgeon)
The drainless tummy tuck is a reasonable procedure in the right patient. The right patient would be someone with a low BMI and no aggressive liposuction of adjacent areas. In order for a drainless tummy tuck to be successful, numerous progressive tension sutures are required.
Even then, a drainless tummy tuck patient is still at a greater risk for a seroma formation than one with a drain. If you were to develop a seroma, it would require needle aspiration in the office weekly until resolved.
For my patients, I perform progressive tension sutures in addition to placing a single drain with my tummy tuck procedures because I would rather my patients not experience a postop complication like a seroma if at all possible.
Thats not to say that I would not consider a drainless TT in the ideal candidate if that person was willing to accept the additional seroma risk. Each surgeon has their own preferences. I suggest consulting with a board certified plastic surgeon who has experience with the progressive tension suture technique and uses it for all TT procedures. (Nicholas Tarola, MD, Nashville Plastic Surgeon)
Drain this tummy tucks are safe.
Early in my career I use drains on all abdominoplasties. This was done to decrease the risk of postoperative seromas. I now use a quilting technique without drains and have almost eliminated seroma formation my patients. (Vincent N. Zubowicz, MD, Atlanta Plastic Surgeon)
Safety of drainless tummy tucks
Using drains after a tummy tuck can help prevent buildup of serous fluid. In my practice I use drains unless I place quilting sutures between the body wall and deep surface of the abdominal skin flap (progressive tension sutures).
The problem with progressive tension suturing is that it does not allow the abdominal skin to evenly distribute tension. This can (rarely) lead to excess fullness above or below the belly button. Since there is very little risk and only minimal discomfort from drains I am more prone to use them and to avoid the quilting progressive tension suturing technique.
This minimizes the risks of needing more procedure. Each surgeon will have his or her own take on this. Consult a surgeon certified by the American Board of Plastic Surgery. (Daniel Greenwald, MD, Tampa Plastic Surgeon)
It would be wrong to think the recovery speed depends on drain or no drain, it does not. But it is true the drain is a bit of a hassle. I personally use one drain in a TT for about 7 days but some surgeons do not.
Pick a good surgeon and then let the surgeon decide how to do the surgery. That’s his/her job. . (Ronald V. DeMars, MD, Portland Plastic Surgeon)
I have always used drains with tummy tuck procedures. They are easy to care for and are removed without pain. I do believe they are essential with an aggressive tuck that gives you better results.
Some doctors do not use drains and then have to do more work within the tummy wall to avoid a fluid collection. Scientific studies do show that the incidence of seroma (fluid collection) is low with that technique.
I prefer to drain and my incidence of seroma is quite low. I do not believe that drainless tummy tucks heal any quicker than those with drains. and get advice from several experienced, board-certified plastic surgeons. Be sure to ask to see before and after pictures as well. (Robert J. Spies, MD, Paradise Valley Plastic Surgeon)
With quilting and progressive tension suture techniques it is possible to do a drainless tummy tuck but this results in a risk of seroma that will require repeated needle drainage. It can get infected and if this happens, the wound will need to be opened.
I prefer to do the quilting and progressive tension suture techniques and use a tiny drain for a week. This is not painful at all and in my opinion is safer than not using a drain.
“Drainless tummy tuck” is more marketing hype than anything. (John Squires, MD, Denver Plastic Surgeon)
The procedures that are promoted with drainless tummy tucks – progressive tension sutures between the tummy tuck flap and the underlying fascia, preserving the subcutaneous fat and superficial fascia, etc. – can also be performed while still utilizing drains.
In smaller tummy tucks it may be reasonable not to use drains; however, in larger or extended tummy tucks the benefits of have a drain – decreasing the risk of a seroma – may well outweigh any problem their use may pose.
Check with your surgeon for their recommendations regarding the use of drains in your case. (Vincent D. Lepore, MD, San Jose Plastic Surgeon)
Each individual surgeon has a different opinion regarding drains. Although not having a drain is nice you should have a drain if it will avoid a seroma. There is a lot of good data on progressive tension sutures.
However in my experience patients with a high Body mass index still benefit from a drain. I would trust in your surgeon. (Theodore Nyame, MD, Charlotte Physician)
You should let your surgeon choose the procedure that will work for you.
Drainless tummy tuck does not guarantee that fluid will not form and collect after tummy tuck. If you were to form seroma after a drain less surgery you will need drains to treat the problem.
Let you surgeon decide if you are a candidate for drain less technique. Drains are always extra security in everyone and every case. (Vasdev Rai, MD, Dallas Plastic Surgeon)
Some surgeons are reluctant to change. Not much of a controversy here though, as we have discontinued drains on tummy tuck for many years as have other practices. There are no additional risks, and the recovery is much easier without. (Peter E. Johnson, MD, Chicago Plastic Surgeon)
Several surgeons like this technique. I personally use drains to help prevent seroma and/or hematoma. (Donald Nunn, MD, Atlanta Plastic Surgeon)
Drainless Tummy Tuck is a Safe and Effective Procedure in Experienced Hands
I have performed drainless tummy tucks for many years andhave found it to be a safe and reliable procedure when performed in appropriatesurgical candidates. I have not had anyproblems with seromas. The length ofsurgery is increased somewhat, but I have been able to shorten my operativetimes by using a suturing technique which is somewhat different that istypically described by other surgeons.
I use a continuous stitch which is woven back and forth to secure the overlying fat to the underlying muscle fascia (fibrous covering of a muscle). An average of 10 to 15 minutes is added to the length procedure, however, the closely woven continuous stitch that I useallows me to completely close the “dead space”, which is the reason I have not had problems with seromas.
In my experience, the extra time is very well justified,because all of the potential problems associated with drains have been eliminated. Because the tissues are securely attached to one another, healing between the fat and underlying tissues beginsimmediately.
This allows patients to be more active during the early postoperative period, which in turn helps prevent potentially fatal clots from forming in the legs. I believe that conflicting views between surgeons are often theresult of varying levels of experience with a particular procedure.
In fact, a new study confirms this, showing superior results of the Drainless technique over that with drains. Therefore, I would advise you to find a boardcertified plastic surgeon that has significant experience and success withdrainless tummy tucks. (David F. Pratt, MD, Kirkland Plastic Surgeon)
It is possible to have a tummy tuck without drains, but it is a trade off. As a result of the progressive tension sutures, the skin is not pulled as tight in my experience (patients are able to stand upright because not as much skin is removed).
Also despite the fact that they say that no drains are used does NOT mean that you won’t get a seroma (fluid collection) that may require drainage in the future. I would say that the majority of plastic surgeons use drains routinely.
I’m glad you are doing your homework and educating yourself. In reality what you really want is a plastic surgeon that gets great results and who has happy patients as a result of their skill and expertise.
Don’t choose a surgeon just because they tell you what you want to hear. If it is a good technique and you like the results and they have happy patients then you can be reassured that you may expect a similar outcome. (Richard H. Fryer, MD, Salt Lake City Plastic Surgeon)
A properly done tummy tuck involves considerable dissection, and that causes significant fluid accumulation. You need a drain. It is your friend, as if fluid remains in your abdomen, you will be bloated and unhappy. (Kenneth D. Christman, MD, Dayton Plastic Surgeon)
Drainless vs drained tummy tucks
Modern tummy tucks are for the most part virtually drainless. We are now down to a single small drain where we used to use two large drains. Our less invasive tummy tucks requiring shorter incisions often do not require drains or only small drains for a few days.
However if you do form fluid in the ‘drainless tummy tuck’ you would be happier if a drain had been placed. But as many of the esteemed colleagues have noted, it’s better to choose a surgeon whose reputation accrues from thousands of successful cases performed over decades rather than choosing a particular technique. (Brent Moelleken, MD, Beverly Hills Plastic Surgeon)
Which would you recommend; drain or drainless Tummy tuck?
Your thoughts that the drainless TT has no sutures to remove, less swelling and quicker recovery has absolutely nothing to do with the presence or absence of a drain. It relates to the progressive advancement closure technique.
It is definitely the way to go but I still use a drain with it for a few days. That does provide less swelling and less risk of a seroma. (Ronald V. DeMars, MD, Portland Plastic Surgeon)
Variations in tummy tucks require different approaches with drains and some tummy tucks are done without drains. But I personally prefer lipoabdominoplasty technique where there is discontinuous undermining from the belly button up and residual lymphatic tissue left behind on the lower abdomen.
There is really very little ‘dead space’ from this procedure. I still employ one drain so I can sleep better. The drain comes out from an access site used for the liposuction of the tummy and it does not affect your ability to ambulate or stand straight up.
I do use pain buster catheters that continuously drip a local anesthetic into the sutured muscles and the drain helps clear this as well. (Curtis Wong, MD, Redding Plastic Surgeon)
The drain less tummy tuck has only been around for a few years. At my clinic I use this method and find that patients are more comfortable and tend to heal faster.
I found that when I did use drains, the patients found them inconvenient and uncomfortable. Having said that however, regardless of which technique is used by your surgeon, it is their experience and the end result you will receive which is most important.
You must be comfortable and confident that your surgeon will give you the results you are looking to achieve. (Frank Lista, MD, Toronto Plastic Surgeon)
I personally have never been able to get drainless abdominoplasty procedures to work as well as some people have described. There’s a high seroma rate that goes along with it that for me is just something I’d like to avoid when possible.
Even on favorable cases (small lipoabdominoplasty) it’s usually less problem to drain for a few days then have to repeatedly aspirate small seromas (which is often the case sans drains). (Robert Oliver Jr., MD, Birmingham Plastic Surgeon)
Why so many Doctors use drains?
I am always interested in what patients glean from the internet and other sources. First of all, drains have no relationship to anesthesia in any way. Drains are used by Surgeons in many types of operations to remove fluid that can collect under the skin.Putting drains in preventatively usually prevents fluid collections (Seromas) that can be very painful, get infected and require multiple drainage procedures and even further surgery. Some Plastic Surgeons have been placing additional stitches under the skin to decrease the space and hopefully prevent the need for drains (“Drainless Tummy Tuck” as seen on the “Internet”).
However, after this surgery if fluid accumulates, the surgeon will need to drain it or place a drain at a separate procedure. In my practice I have elected to use drains to prevent Seroma formation and have not had a Seroma in over 5 years and 300 cases.
However, doing otherwise is up to the individual surgeon and acceptable as long as they are prepared to drain the seroma if one develops despite the sutures. Remember when you go to 2 doctors you get 3 opinions.
I would choose your Plastic Surgeon based upon their experience and results, not a drain. (Donald W. Hause, MD, Sacramento Plastic Surgeon)