One of the most common questions that we get is: Do I need drains for my tummy tuck? The short answer is: no. Thanks to the development of techniques called progressive tension sutures, there is no longer necessarily a need that helps avoid the need for drains in a tummy tuck or mommy makeover.
Let us take a little bit deeper dive into why drains are used in the first place. Historically, we are lifting the abdominal flap because we are going from the top of the abdomen all the way down to the pubic bone. This is done in an effort to remove any extra skin while tightening your muscles down the midline and internal corset before advancing that skin flap forward. This is what lets us remove the extra skin and fat, ultimately strengthening and contouring the abdomen.
Anytime the skin or abdominal flap is lifted, a cavity or space is created where bodily fluids can easily accumulate. The key concept to understand is that your body produces fluid in areas that have experienced some sort of stressor, no matter what that may be. If you have a sprained ankle, your body is naturally going to send fluid to that area. This is no different than what happens during a tummy tuck, as your body is merely sending fluids to the region that has recently been worked on.
Before the innovation of the drainless tummy tuck and progressive tension sutures, it was considered a common practice to implement drains to help remove this fluid. While fluid buildup is natural, if you have a large amount of fluid, the body will not be able to absorb it. As a result, it can create what’s called a seroma, or a fluid collection. Not only can this be uncomfortable or unpleasing for many patients from an aesthetic standpoint, but it may also require further surgical intervention to fully address.
At our practice, we take a different approach to treating this by using progressive tension sutures. What this means is that as we advance the skin flap down during a tummy tuck, we put sutures, typically on the inside underneath the abdomen, which then tack the flap down. This recreates the abdominal area and the natural architecture of the abdomen, so there is no longer a big space to collect fluid. Because these sutures have been tacked down, the body can do its work. There is no longer a large space for that fluid to collect, which has been priceless.
Progressive tension sutures also help take tension off the incision, which helps your scar form better. It is important to note that if you do a drainless tummy tuck, you still have about a 10% chance of getting a seroma or fluid collection afterward. These are all merely examples of some of the benefits of a drainless tummy tuck. A few other advantages commonly associated with a drainless tummy tuck may include:
- Comfort. The drains can be painful. They can be irritating. They can limit people’s mobility.
- Increase in mobility. One of the big movements in plastic surgery is to get people up and moving as fast as possible following their procedure. Drains may make this more challenging for the patient. As such, a drainless tummy tuck allows us to do what we truly believe is going to help the patient on their road to recovery.
- Scarring. Drains can leave an extra scar at the site where the fluid is coming out. If the drains come out prematurely because they get pulled on or caught on something, then you are left without a treatment for that fluid, which may result in the need for serial drainage of the stomach.
With all this said, there are situations where a drain may be necessary, and this all depends on your plastic surgeon and your specific situation. Progressive tension sutures and the drainless tummy tuck have been one of the biggest innovations and evolutions of a tummy tuck and mommy makeovers, because they decrease the biggest hesitation for patients, which is having a drain.
The drainless tummy tuck can make the postoperative period much more challenging, as it makes it more difficult for some patients to get up and move around. Many of our patients are busy individuals or mothers, and the drains are limiting their activity. As such, it is important to discuss with your plastic surgeon whether or not drains are right for you. The vast majority of our patients do not get drains, as we often use a progressive tension suture and a drainless tummy tuck for the majority of cases.
In the end, whether or not to include drains in your tummy tuck is something that should be discussed in detail with your surgeon, as each patient and their subsequent goals are unique.
