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What is a drainless tummy tuck?

Posted May 08, 2018 in Tummy Tuck (Abdominoplasty)

More and more surgeons are finding that tummy tuck surgery can be completed without the need for drains. The topic of drainless tummy tucks comes up in most of my consultations, so it seems appropriate to discuss the issue a bit in this forum.

What is the purpose of a drain and why would you need one?

During my residency training, every patient that had a tummy tuck received two drains to help remove excess fluid that builds up under the skin after surgery. There is always trauma to the skin and soft tissue during a tummy tuck that causes the body to react with the development and accumulation of fluid. The purpose of this fluid is the body’s natural response to any type of trauma. The body senses an injury and it dilates both blood vessels and lymphatic vessels to help deliver inflammatory cells to the area of injury. This inflammatory fluid will build up in the area of injury if there is a place for it to accumulate. During a tummy tuck, the skin is separated from the abdominal muscle fascia and it takes weeks to months for the skin to become adherent again. If fluid is accumulating, it will push the skin away from the muscle fascia and create somewhat of a water balloon. This balloon full of water is called a seroma and if left untreated, the body will cause the lining of the balloon to become thickened. If this happens, the seroma can become somewhat permanent and difficult to get rid of. It can lead to infections and discomfort and should be avoided if at all possible. Because of this, many surgeons will place a drain or two under the skin to help eliminate this fluid. This allows the skin to deflate and be more likely to become adherent again to the abdominal wall muscle fascia again.

How can you do a tummy tuck without a drain?

We have found that inflammatory fluids are low pressure fluids and will only accumulate if the pressure is low enough. If this fluid is accumulating in a “balloon” of skin, it will continue to do so until the pressure inside the balloon is too high for it to continue to swell. When this pressure is reached, the fluid will find a new place to go that has a lower pressure, which is typically back into the blood vessel or lymphatic vessel where it originated. Some really smart plastic surgeons found that if the skin is fixated back down to the abdominal wall with either sutures or glue, the skin does not swell and the fluid cannot accumulate. It is basically the equivalent of gluing the lining of a balloon together and then trying to blow it up. I accomplish this in my surgeries with sutures or stitches which are called progressive tension sutures. They serve to fixate the skin back down to the muscle fascia and it minimizes the body’s ability to develop a seroma without the need for drains.

Why don’t all surgeons use progressive tension sutures and eliminate drains?

This is a good question. I have found that all of my patients prefer to not have drains and that only a small subset of patients actually need drains if some type of fixation technique is employed. Surgeons that continue to use drains do so for one of two reasons.

  1. They just are not familiar with the newer techniques of progressive tension sutures. There are some surgeons that may not be exposed to new ideas and simply do not know that there is a different way to do things than how they were taught in their training.
  2. They know about the techniques, but just don’t want to try them. There are many great surgeons that have been doing great work for many years and simply do not see the need to change their way of doing things. In their minds, if it isn’t broke, why fix it. These surgeons can not really be faulted. They get great results and they have happy patients. I hope that as I continue to become more senior in my practice, I don’t close my mind to new techniques that could keep me current and up to speed with more innovative thinkers.

What are the other benefits to drainless tummy tucks?

Drainless tummy tucks offer several benefits.

  1. Less hassle. Walking around with tubes and bulbs hanging from your body is annoying during the day. They are difficult to hide in clothes. At night, they are a nuisance and can affect your sleep due to both discomfort and for the fear of rolling over on them or having them pull on the skin.
  2. Lower risk of infection. Although I have not seen a clinical paper detailing this benefit, it just seems obvious that if there is not a open hole in the skin from a drain, the risk of infection should be lower.
  3. Easier recovery. Even though there really should not be a difference in the recovery experience with or without drains, I can say without a doubt that patients without drains report less pain and an easier recovery. I think that much of this is psychological, but real nonetheless. A patient with drains looks at the drains and assumes that their surgery is more extensive and should therefore be more uncomfortable than the patient that does not have drains. The patient that showers normally, sleeps normally, and walks around without the hassle of drains tends to be more happy and thinks that their recovery is more easy. And this is perceived as less painful and easier.
  4. Scars are better. Since I have been using progressive tension sutures, the tummy tuck scars have healed better for my patients. The reason is that the tension on the suture line is distributed more evenly throughout the skin instead of just along the stitch line.

As you can see, I am a big fan of the drainless tummy tuck. If you have more questions about the technique or are interested in finding out if it would be an option for you, please call us and set up a consultation.