Drainless Tummy Tuck

Some plastic surgeons use a technique developed several years ago to perform a tummy tuck without placing surgical drains for postoperative care, aptly known informally as a drainless tummy tuck. I describe the technique below and also demystify the process of maintaining a postoperative surgical drain for a short period of time.

When I perform tummy tuck surgery, I temporarily place two surgical drains in the incision, one on the left and one on the right. These surgical drains are a closed-suction device to collect sterile lymphatic drainage, a bodily fluid, near the surgical site. Technically called Jackson Pratt drains after the physician who invented them in the 1970s, they differ from other kinds of surgical drains and are the most common type of drain I use in cosmetic surgery. They consist of a “grenade” shaped bulb with a plug and tubing. I place the drains underneath the abdominal flap, and they exit through the incision with the tubing and bulb external to the abdomen. I close the incision around the surgical drains intraoperatively, and the drains stay in place for one to two weeks. These drains require very little maintenance by the patient. They need to be emptied of fluid twice a day, and the patient or caregiver must record the amount of fluid collected in the previous twelve hours. (We show you how to do it in properly in postoperative recovery before you leave.) Once the collection of fluid is below a certain level, I can remove them. The patient may shower with these drains, and the drain site simply needs to be kept clean. I remove them painlessly in the office once eligible, and they create no additional scar due to the placement in the incision itself.

While patients are often new to the idea of having a device hanging off of them, after a short discussion, they understand the need. Any new “spaces” inside the body will collect fluid. Especially with my tummy tucks, which often include a significant amount of fat removal via liposuction as one of my techniques to create a feminine, hourglass waistline, patients will have drainage in the first week after surgery. Surgical drains help prevent infection and seromas, a collection of fluid inside the body that may itself become infected. The body will reabsorb a small seroma on its own, but otherwise, the plastic surgeon must drain it manually. Seromas can also reaccumulate several times and be forced to be drained before finally resolving. We, plastic surgeons, strive to avoid seromas in all cosmetic surgery, but it is a common surgical complication. Thankfully, I don’t see many of them in my patients.

So then, what is a drainless tummy tuck? As you might imagine, it is a technique where the surgeon does not place drains in the incisions. Instead of putting drains, the tummy tuck surgeon places Progressive Tension Sutures, or quilting stitches, sewing the underside of the abdominal flap to the abdominal wall with dissolvable material. In theory, if you close down “dead” space, you won’t have fluid collections because the body will reabsorb any fluid. In practice, this technique leads to a significantly higher rate of seromas, although there was a medical study published in October 2016 contesting this point. Consensus among plastic surgeons, though, is still that a drainless tummy tuck has a higher potential for complications and the formation of seromas and hematomas. In addition, it extends surgical time by up to an hour (a 33% increase), and overall, it is best to be under general anesthesia for shorter timespans. Finally, it is common for patients who underwent the drainless tummy tuck technique to end up with visible external dimples (dents) where the quilted stitches were placed to sew down the underside of the abdominal flap. However, there is the possible benefit that the patient can become active a little sooner after surgery, but that isn’t necessarily a good thing. Stressing the surgical site too soon can impede internal healing, potentially harming the long-term result.

As your surgeon, I love surgical drains. They help you avoid complications! And, because they are easy to maintain, there is essentially no downside to placing them. In any case, the placing of surgical drains or not is a very small part of the abdominoplasty procedure, and you should not choose a plastic surgeon on that basis. It is far more important that you are comfortable with your tummy tuck surgeon’s ability to manipulate the abdominal muscles and tissue, and in the case of my tummy tuck procedure, perform high quality liposuction. The key question is “Will your plastic surgeon create the fit, feminine, hourglass silhouette you desire?” I would advise you to form your opinion based on the surgeon’s previous work in the form of before and after patient photos and on an in-person interaction. In my opinion, while the drainless tummy tuck technique isn’t new, it is mostly a marketing technique that surgically carries risks. I do not currently perform a drainless tummy tuck.

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