Abdominoplasty, do I need a drain?
Abdominoplasty can be performed with or without a drain. We use both techniques at Blue Water Plastic Surgery, and the decision to use a drain or not when we plan a tummy tuck surgery is based both on patient preference and the recommendation of your surgeon.
There is always tissue fluid that leaks from microscopic lymphatic channels in the abdominal skin flap after a tummy tuck, and the conventional way of managing this is to place a drain during the surgery. A drain is a soft plastic tube that connects to a suction bulb, which collects the tissue fluid as the surgical site heals. Most commonly two drains are placed and one is removed at the end of postop week one, while the second is removed at the end of postop week two.
In drainless tummy tucks, so-called ‘quilting’ sutures are placed that anchor the abdominal skin flap to the abdominal wall, so that accumulating fluid cannot ‘float’ the abdominal skin away from the abdominal wall, forming a visible seroma. The fluid is still there, but because the skin remains adherent to the abdominal wall in places, you don’t see a seroma.
Both techniques can work well, so here are three important considerations when patient and surgeon are considering a drainless tummy tuck:
The first consideration is that the amount of fluid that is formed tends to increase with increasing thickness of the abdominal skin fat layer – so there’s more fluid that is produced in heavier patients. So we generally use two drains in patients with higher BMIs. We may also place quilting sutures, by the way, which means that the drains will in most cases be needed for a shorter amount of time than if quilting sutures were not placed and we were relying on a drain only to prevent a seroma.
The second consideration is that in thin patients the quilting sutures can be very easily visible, and the indentations that they create in the abdominal skin may not completely disappear. In our thinnest patients we usually place drains, and because thin skin flaps do not leak much lymphatic fluid, the drains can often be removed after just a few days.
The third consideration is whether or not significant liposuction is being performed along with the abdominoplasty procedure. I generally recommend a drain when a tummy tuck is combined with liposuction because the volume of fluid that drains postoperatively is greater, especially in the first two to three days after surgery, and in my experience the chance of seroma is lower if a drain is placed.
At Blue Water Plastic Surgery our focus is on providing you with an individualized abdominoplasty treatment plan that best serves your needs, and that will get you back to a non-strenuous daily routine as quickly as possible. When looking for a tummy tuck surgeon, I would strongly urge you to not let the issue of whether or not you will have a drain for a week or two postop be the deciding factor. Instead, make your decision based on which surgeon you think is most likely to provide you with a beautiful surgical result, which should include a very natural-appearing belly button by the way, and who you think is most likely to get you through the process of having a tummy tuck safely and with the least amount of discomfort. The importance of those issues is much, much greater than whether or not you have a drain for a week or two after your surgery. Which you probably won’t even remember when a girlfriend at the pool asks you about your amazing tummy this summer.
