Why No Drains with Abdominoplasty?

Abdominoplasty without the use of drains

 

Abdominoplasty, also known as tummy tuck, is an increasingly popular cosmetic plastic surgery procedure. Last year, over 150,000 abdominoplasties were performed by board-certified plastic surgeons in the US, and perhaps many more by less-qualified medical practitioners. Recently, I was asked again by a cosmetic patient why I do not use drains for my tummy tucks, so I thought I’d explain it.

Here is some information about tummy tucks:  https://www.tavmd.com/surgery-info/tummy-tuck/

and here are some before and after photos of tummy tucks: https://www.tavmd.com/cosmeticsurgeryphotos/full-tummy-tuck/

What is a tummy tuck?

Tummy tuck surgery involves three basic surgical maneuvers:

  1. Removal of the skin between the belly button and pubic area with a resultant scar in the bikini line
  2. Tightening of the rectus muscles (six-pack muscles) from the breastbone down to the pubic bone
  3. Liposuction of the abdomen, flanks and hips

Essentially, the skin of the abdomen is elevated off the muscles of the belly, pulled down and re-sutured. This creates an “open space/dead space” under the abdominal skin that the body will fill with fluid similar to the fluid that accumulates under a blister when you burn yourself (seroma fluid, or blood without the blood cells!).

In time, the skin will heal with scar tissue as it attaches to the underlying muscle again, obliterating the open space. However, for the few weeks immediately after surgery, open space can be the cause of some post-operative tummy tuck complications.

Here is a link to a movie schematic about how abdominoplasty is performed (scroll down to see the Tummy tuck movie)
https://www.tavmd.com/cosmeticsurgeryphotos/plastic-surgery-movies/

Drains and tummy tucks

In the older techniques of abdominoplasty, still practiced by many plastic surgeons, the open space is encouraged to heal by placing a drain under the skin. The drain comes out of the pubic area into a reservoir where fluid is collected and thence discarded. The “blister fluid” produced by the body is sucked out, the dead space closes with time and the skin adheres. The drain is usually left in for 7-14 days depending on the amount of fluid the body produces.
Abdominal drains have their downsides. They can:

  • Cause pain on movement
  • Create a source of infection
  • Actually increase the rate of seroma fluid production!

 

 

Abdominoplasty without drains

A number of years ago, a new technique emerged from Texas created by Dr. Pollock for closure of the tummy tuck without drains. This “progressive tension sutures” method involved placing sutures (stitches) between the skin of the abdomen and the underlying muscles, in effect obliterating the open space and allowing for faster healing of no drains with abdominoplasty. The technique adds a few minutes of time to the surgery but has a number of benefits:

  • less pain
  • less risk of infection
  • faster ambulation of patients
  • less risk of seroma occurrence

All of these advantages increase the value of the progressive tension suture technique over the use of drains in tummy tucks.

As with all surgical techniques, it takes years, in fact decades, for surgeons to change the way they perform a procedure. Surgical training is such that plastic surgeons learn particular techniques during their residency and go on to perform the same procedures for the duration of their  30-year careers. It takes real conviction to switch from what your professor told you to do to a new method, but that is the only way plastic surgery science can possibly advance!

Morad Tavallali, M.D., FACS