What Is A Drainless Tummy Tuck

Drainless Tummy Tucks are in demand, and for good reason.  Who really wants one or two drains to take care of after their tummy tuck?  Drains are uncomfortable, the get in the way, they freak people out, and everyone’s afraid to have them removed.  (Many types drains can hurt when they come out, but when we do use drains, we use a type that would slide right out if it wasn’t sutured.  Often people don’t know we took one out already.)  To understand the advantages and disadvantages of drainless tummy tucks, we better talk about tummy tuck basics first.

When we do a tummy tuck, we make the lower incision and then lift the skin and fat off the muscles up to the ribs.  After that we can tighten the muscles, pull the skin tight, remove the extra, and suture things closed.  But if you think about it, we made a big cavity in there between the skin and fat on top (patient is laying down) and muscles on the bottom.  This raw area is going to fill up with fluid, just like a blister fills up with fluid from the raw surface underneath the skin.

After a tummy tuck, the fluid collection (seroma) then becomes like a waterbed sloshing around in there if you don’t do anything to prevent it.  That’s because if you leave the fluid, the top surface can’t heal to the muscles because there is fluid in the way.  Even worse, the longer it stays like that -with the surfaces pushed apart by the fluid- the lower the chance that they will ever heal together.

SOOO- that’s why drains have always been used in tummy tucks to suck that fluid out until the 2 surfaces heal together and there is nowhere for the fluid to collect.  Once it is healed and there aren’t 2 raw surfaces anymore, there is nothing to produce the fluid.  So the drainage into the tubes then slows way down and we remove the tubes.  This is how tummy tucks have been done for decades and it works well but can take even 2 or 3 weeks sometimes for things to slow down enough to remove the drains.

But now drainless tummy tucks are well-accepted and many patients ask for that option.  These work by using many small “quilting” sutures on the inside to sew the skin/fat layer down to the muscles, thus closing-down the cavity where a seroma would form.  The sutures hold the top surface down to the bottom/muscle surface so that they heal together without moving.  As is the case with many body contouring techniques, the drainless tummy tuck became developed in South America first.  Although the concept was met here with skepticism, the technique has been proven in a few studies to work well and not cause more seromas despite not having drains.

BUT the devil is in the details!  Sometimes the authors have defined seromas as problems necessitating another surgery back in the operating room to treat a really bad seroma that’s not getting better even with draining with needles in the office!  Usually, a small seroma is just drained through the skin in the office with a needle and syringe a couple of times a week.  (this sounds awful, but the lower part of the tummy skin usually has no sensation right after the surgery.)  Eventually there is less and less fluid to drain and then we stop.

In MY opinion, though, ANY seromas (even little ones) should be avoided and are inconvenient for the patient.  Therefore, I do drainless tummy tucks when I think it is appropriate.  Some patients are lower risk for a seroma, like thin patients who do not require concurrent liposuction of the tummy or love handles. In other patients (those with a lot of liposuction or obese patients especially), I still do the quilting sutures to close-down the large cavity, but also put in one or sometimes 2 drains.  By using the quilting sutures, we sometimes can get out both drains in 2 or 3 days instead of the old 2 or 3 weeks!  Often, I think that this “hybrid” approach is the best balance of convenience, comfort, and caution for the patient.

I think drainless tummy tucks are a great advance in plastic surgery.  They can be an appropriate option for some patients.  But no technique is really “one-size-fits-all”.  We just need to take all the variables into account and decide together what is best for you.