Tummy tuck (abdominoplasty) surgery is one of the leading procedures annually, with nearly 243,000 procedures performed in 2021. Great advances have been made in the tummy tuck procedure over the last 15 years, one of which is the elimination of drains. For the past 9 years, I have been performing drainless tummy tuck procedures at my St. Louis-area plastic surgery practice.
Ask anyone who has had a tummy tuck and often what you hear is, “The worst part of it was the drains.” This is why it is so shocking for me to discover that most plastic surgeons still use drains when completing a tummy tuck since a drainless approach leads to a much more pleasant recovery experience.
Why Do Some Surgeons Use Drains?
My drainless approach sometimes comes as a surprise to many of my patients, who often ask the question, “Why does it seem like everybody else tells me I need drains?” My reply is usually “I don’t know.”
It’s a tough question for me to answer because, like my patients, I’m not sure why they do either. I can only speculate and respond with, “Remember when people were reluctant to give up their landlines and switch to cell phones?” I must assume physicians “have done it this way my entire career” and have not progressed with new techniques and the latest advancements.
Preventing Seromas Without Drains
Traditionally, the purpose of drains has been to prevent seromas. Seromas are basically a fluid collection that can occur whenever there is space to fill. For example, imagine there is a hole in your backyard and it rains. That space will fill up with water. Our body is mostly comprised of water, so anytime there is a space left after surgery, this can fill with fluid as well.
So how do we do this without drains? By using a technique known as progressive tension abdominoplasty or tummy tuck—you can see an illustration of this suture technique in our related blog post. What we do is start from the top of the open space and work our way to the bottom, closing all of this space with sutures as we go. It’s the equivalent of filling in the hole in your backyard so the water can’t collect.
What’s remarkable is that the literature is very clear: seroma rates without drains are approximately 1/3 the rate of these fluid collections when we do use drains. That’s right; the purpose of the drain is to prevent these fluid collections, and by using the drain the fluid collection rate is 3 times higher!
More Benefits of a Drainless Approach
I also believe by not using drains and suturing this space closed, starting from top to bottom, and putting tension all the way down the abdomen as we close, we can get your stomach tighter than ever before, have better control of the scar location, take tension off the scar and minimize its appearance. Further, if there are healing problems, they are often easier to manage because there is less tension at the scar.
So what’s the downside? Perhaps the only downsides I can see without drains are that it takes a few more minutes to close the space and my patients take a little bit longer to stand up straight after the procedure. Why? It’s because I’ve been able to get their abdomen tighter than ever by distributing the tension across the entire abdomen rather than just at the scar. This is a negative that patients ultimately thank us for!
The Transformative Power of the Tummy Tuck
The tummy tuck is one of my favorite procedures. Whether you are having a tummy tuck after significant weight loss, as part of a mommy makeover after pregnancy, or for any other concern of excess skin of the abdomen, the results can be astounding. Nothing makes me happier than to hear a patient walking into a consultation saying, “Well, it’s not like I’ll ever wear a bikini again,” and then saying in their surgical follow-up visit, “Well, it happened. I went to the beach in a bikini and loved it.” It gives me tremendous satisfaction to see the impact this procedure can have on patients’ lives.
To see the difference this procedure can make in our patients’ appearance, scroll through the before and after photos below and visit our photo gallery.