How long should drains stay in after a Tummy Tuck surgery?
I haven't had the Tummy Tuck yet but I'm preparing mentally and physically for it. Why are drains necessary after a Tummy Tuck? Where does that fluid come from? Are they always needed?
Thank you for your question. Most Plastic Surgeons these days still use drains after a tummy tuck - I do, too. They are necessary because the upper abdominal skin and fat is lifted off of the abdominal wall and then pulled down. This creates a lot of potential space, and the underside of this flap can weep fluid as it heals. The drains help to remove this fluid to ensure that the tissues heal appropriately. I usually put in two drains with a tummy tuck. With most of my patients, the first one comes out at day 3 or 4 and then second one between day 7-10. A lot of these depends on the amount of fluid that is draining - in revision cases, or in cases where the amount of dissection (the lifting of the abdominal skin and fat) was extensive, I may leave them in longer. Some Plastic Surgeons do not use drains, and use Progressive Tension Sutures. These are stitches that are placed in the upper abdominal skin and fat that tack down this tissue to the abdominal wall. These stitches help to eliminate this "dead space" and some Plastic Surgeons do not feel then that they need drains. For me, however, I still use them just to avoid a fluid collection (or a seroma), which can potentially become infected and complicate healing. Best of luck!
We take drains out as early as 3 days sometimes, and as late as 2 weeks other times. More recently we've been doing drain-free tummy tuck surgery in the right candidates, which is very exciting. Be sure to discuss your goals and concerns with your board certified plastic surgeon and consider the pros and the cons. Be certain your surgeon is properly certified.
A tummy tuck tends to leave space between the layer of fat and the layer of muscle in your abdomen. As part of the healing process, your body produces fluid and releases it into this space. The amount of fluid is usually too much for your lymphatic system (a network of vessels that help absorb fluid and redirect it back into your circulatory system) to deal with, as your lymphatic vessels typically sustain some damage during the procedure. Therefore, a postoperative lymphatic drain is used.
This drain essentially creates suction between the abdominal wall and the abdominal skin, and helps drain away the fluid. Without the drain, there’s a risk that large amounts of fluid could accumulate in the space, which may cause it to rupture the incision or potentially lead to an infection that would require further medical attention.
The length of time between operation and drain removal will vary depending on your specific circumstances. Most surgeons make a decision to remove the drain based on the volume of fluid being drained over the course of a day. If your drains are consistently putting out less than 30 ccs of fluid within a 24-hour period, your surgeon may decide that you can safely have the drain removed. As a general rule of thumb, I’d say that most drains are removed within about one or two weeks.
It's worth noting that surgical drains are not your only option when it comes to preventing seroma formation. Some surgeons have begun using progressive tension sutures, which hold the tissue together and reduce the space in which fluid can accumulate. This is a relatively new technique and it does carry some risks, so be sure to have a chat with your surgeon for more information about whether this approach is right for you.
Dr. Kimberly Henry has 2 Tummy tuck before & afters:
After abdominal cosmetic surgery, including tummy tucks or mini-tummy tucks, it is common for serous fluid to collect in pockets beneath the skin. The goal is to remove this serous fluid as quickly as possible to allow the area to heal faster. By using special surgical drains with attached drainage tubes, plastic surgeons can prevent a buildup of fluid beneath the skin.
The fluid consists of a natural combination of blood plasma and inflammatory fluid -- both of which are the result of damage caused by the tummy tuck procedure. (Serous fluid is not blood, nor the result of an infection).
Some doctors do not use tummy tuck drains or drain tubes and instead opt for a technique called "mattress sutures". Mattress sutures (also called "progressive tension sutures" or "quilting") are multiple small stitches that prevent internal spaces from developing. By eliminating internal space, the serous fluid does not have an internal pocket in which to collect. Mattress or progressive tensions sutures also have the advantage of reducing the amount of tension on the primary incision, which can expedite healing and reduce scarring.
The use of surgical drains for fluid collection is a common element of mommy makeovers and tummy tuck surgery. The choice of whether to use drains will depend on your plastic surgeon and your specific situation.
Always visit a board-certified plastic surgeon for the best results.
Robert Brueck has 1 Tummytuck before & after:
Tummy tuck surgery often leaves a space between the abdominal skin and the abdominal wall. Following surgery, this space naturally fills with a substance called serous fluid. The serous fluid is composed of a combination of blood plasma which leaks out from ruptured blood vessels and inflammatory fluid that is produced by damaged tissue. If this fluid is not drained, it will result in a localized collection called a seroma.
If seromas persist for a sustained period (weeks to months) without being drained, your body will form a scar capsule around them to contain them. This may cause the neighboring tissue to become hard. The only way to address the seroma when this happens is a surgical procedure to drain it and remove the surrounding scar capsule. By using special surgical drains during the post-op period, plastic surgeons can ensure that the serous fluid drains quickly and efficiently, thereby preventing a seroma and expediting recovery.
To answer your question about whether surgical drains are always needed after abdominoplasty surgery: some doctors prefer to use a technique called “quilting”. The quilting procedure consists of creating multiple evenly spaced sutures which reduce the amount of space between the skin and the abdominal wall. By reducing this available space, fluid accumulation is prevented and seromas cannot develop.
Thank you for sharing your question. I tell my patients that the drain typically remains for 5 - 7 days. There are some instances where the drain could be left in longer. It really depends on the amount of drainage that is being collected. It is important to remember that the drain is there to prevent complications. I hope this was helpful to you.
Best Wishes, Dr. B.
A. K. Bhattacharya has 2 Tummy tuck before & afters:
I generally tell patients that they can expect drains for as long as 2-3 weeks. It comes from all the surrounding tissue into the tummy tuck pocket. I do offer tubeless tummy tuck, where I quilt the overlying skin and fat to the abdominal wall, as well as a brand new skin glue. In these cases drains will stay in for a week if I place them at all.
Jonathan Zelken has 4 Liposuction, Tummytuck before & afters: