Do I Have To Have A Drain After A Tummy Tuck?

By Jerome Edelstein, MD

Many people considering a tummy tuck procedure have heard of a drain free tummy tuck and inquire whether or not they are suitable candidates for this new drain free technique. The decision to place a drain isn’t a straightforward yes or no and there are many different aspects to take into consideration before the surgeon will decide.

For over 50 years surgeons have placed drains after every tummy tuck procedure to allow any accumulating fluid, referred to as seroma, a way to exit the body. During a tummy tuck procedure excess abdominal skin is removed and the remaining skin is then repositioned and tightened. This process can create what is medically referred to as “dead space”. Dead space is a new pocket that is created between tissues that are normally connected, in this case, between the skin and fat layer, and the muscle layer. The accumulation of fluid in this created space is detrimental to the healing process and can cause postoperative swelling among other complications. Drains typically remain in place for one to two weeks while the separated layers of skin, fat and muscle rejoin. The exact length of time before your surgeon removes the drains depends on their recommendations at your postoperative examination. Among other things, surgeons typically look for less than 30 ml of fluid draining daily before removing the drain. Many surgeons feel that the body can reasonably reabsorb less than this amount, but not more without uncomfortable swelling, bloating and other potential complications.

Unfortunately, patients often complain that drains are uncomfortable and hinder their day-to-day lives during the healing process of a tummy tuck procedure. In 2009, a method called progressive tension suturing started to become an option. Progressive tension suturing, or drainless tummy tuck procedures, are becoming more commonly requested and favoured by surgeons for a number of reasons. Patients report being more comfortable post operatively and that the healing time is typically less than they expected. The progressive tension suturing method involves suturing the newly separated layers of fat and muscle together with absorbable suture material. The healing time with this method is typically around 10 to 14 days and fluid accumulation is reported as minimal in most cases.

Some patients, however, are not candidates for a completely drainless tummy tuck procedure. In some cases the placement of a small drain is still required in order to achieve the desired outcome and negate any unnecessary postoperative complications. The specific reasons for a drain being placed can be numerous but may include cases with excessive liposuction or patients who are very thin. Nowadays though, even in the cases that require the placement of a small drain, the progressive tension suturing method is utilized in conjunction with the drain. In these ‘combination method’ cases the suturing is favoured first for its ability to spread the tension of the incision site over multiple points in the abdomen, as opposed to only at the specific incision site. The progressive tension suturing is also favoured because it limits the fluid accumulation by eliminating the majority of the dead space. By limiting the fluid accumulation, it allows the surgical drain to typically be removed in less time than without the suturing.

As you can see, there are multiple methods for a tummy tuck procedure. It is always highly recommended to have a consultation with your surgeon. During this consultation time you can discuss your desired body goals and how to best achieve them, estimated healing time, potential complications and any other questions you may have about the procedure. If you find yourself in the Toronto area, consider contacting the offices of Edelstein Cosmetic to schedule a consultation. These medical professionals can be reached at (416) 256-5614.