Traditional Tummy Tucks vs. No Drain Tummy Tucks

A tummy tuck, or abdominoplasty, is a procedure that is meant to tighten the abdomen and give it a flatter appearance. It is normally used on people after they have had either a significant weight loss or (most commonly) after pregnancy because the skin and muscles of the abdomen get stretched out. During pregnancy, the muscle wall gets very loose and the muscles spread apart. More importantly, they round out to accommodate the baby or, with weight gain, to accommodate heavier weight internally. The muscles stretch out and never become flat again. Even a year after pregnancy and birth, the tummy wall never return to its original shape.

MOST UNDERESTIMATED ASPECT

Probably the most commonly underappreciated part of a tummy tuck is that it manages to flatten the tummy wall. Three issues are addressed with a tummy tuck: loose skin, underlying fat, and lax muscles.  Once the skin and fat are dissected, the abdominal muscles are tightened. The tightening of these muscles is key to having a nice, flat tummy after the procedure.

MOST MISUNDERSTOOD ASPECT

A common misconception among patients is they feel that fat is the sole problem causing them to have a poochy tummy. In reality, it is usually a combination of fat, loose skin, and separated and lax muscles causing the problem. If the issue were just fat, liposuction would be an appropriate solution.

During the procedure, an incision is made spanning from hip bone to hip bone just above the pubic bone. All skin and fat between the belly button and the pelvic bone are removed. Any stretch marks in that region are also removed. The surgeon then lifts the skin, all the way up to the breast bone and tightens the muscles from the breast bone down to the pubic bone, in a corset-type stitching fashion. Next, the skin from above the belly button is pulled down and attached just above the pubic bone. In most cases, the scar is so low that it can be hidden by underwear or a 2 piece bathing suit. After a tummy tuck, patients report to having improved self esteem, fitting into their clothes better, and even having improved posture.

NO DRAIN TUMMY TUCK

For decades, (and still today) the more conventional way to perform a tummy tuck was to place surgical drains to prevent fluid from forming between the newly-tightened muscles and the layer of skin and fat above them. Whenever a space is created, the body’s natural response is to fill it with fluid. This collection of fluid, if not removed, prevents the skin and fat from properly healing back down to the muscle.

The no drain tummy tuck is performed exactly the same way as a regular tummy tuck, until it is time to close the incision. Instead of just pulling the skin down and closing the incision, a skilled surgeon uses quilting, or progressive tension, sutures. These dissolvable sutures are used to “tack down” the layer of fat and skin to the muscles in strategic locations from the sternum to the lower abdomen. Adhering the fat and skin to the muscle in this fashion, greatly minimizes any free space where fluid could collect, thus eliminating the need for drains.

NO DRAIN ADVANTAGES

Patient comfort is by far the biggest advantage of the no drain tummy tuck. When drains are placed, the tubes are stitched to the skin at the point of exit to hold them in place. This is, as you can imagine, quite uncomfortable as patients are encouraged to be mobile post-op to avoid complications. Additionally, patients with drains are often very anxious that the drains will be accidentally pulled out as they move about or even sleep. Showering is also very difficult when drains are placed as the drain sites need to be kept dry.

Another huge advantage of not using drains is that the risk of infection post-op is reduced. With drainage tubes placed, there is essentially an open wound where the drains exit the skin through which bacteria can enter.

With a no drain tummy tuck, there is a lower risk of fluid collection. While drains are in, they actively use suction to remove fluid as the body produces it. However, the drains are removed well before the layer of fat and skin have had the chance to completely adhere to the muscles. With the drains removed, fluid will have the opportunity to collect, slowing the healing process. When the progressive tension sutures are used instead of drains, it takes approximately three months for these sutures to dissolve. This provides ample time for the layer of fat and skin to completely and properly attach to the underlying muscle wall.

An indirect advantage of the no drain tummy tuck stitching technique is often a much thinner scar. Because the skin is tacked down in multiple places, the tension on the skin is more evenly distributed than when the wound is simply stitched at the incision site. If all the tension is concentrated on one point, the scar may be much thicker than necessary.

IDEAL CANDIDATE

Some surgeons say a heavier person is not a good candidate. Really, anyone is a good candidate for the no drain method.

COMPATIBLE WITH OTHER METHODS

Patients can use no drain tummy tuck with any kind of tummy tuck. It can even be used with a circumferential tummy tuck which removes some of the skin on the side and the back.

EXTRA PROCEDURE TIME

There is a small learning curve with no drain tummy tuck. In surgery, it takes about 10 extra minutes to put the stitches in but any adept plastic surgeon can easily learn to do this method.

DOWNSIDES OF DRAINS

The downsides of the drains would be the exact opposite of the upsides of not having drains. The downsides include increased infection at the drain site, increased risk of seroma after the drain comes out, decreased patient comfort and increased patient fear of having them pulled out. There is going to be more tension on the scar and less ability to contour the tummy.

RECOVERY

The first week of recovery is easier using the no drain method as there is no discomfort from the drains and patients are able to be more mobile. After the first week, the recovery for the no drain and the traditional tummy tuck are essentially identical. Some studies do suggest, however, that the post-op swelling subsides more quickly with the no drain technique.

COST

The method of using no drains is not any more expensive than having drains used for the tummy tuck. Generally, a tummy tuck can cost anywhere from $8000-$12,000.

FINAL THOUGHTS

Even though tummy tuck methods have evolved over the years, there have been only very subtle changes in the overall aesthetic outcome, or results. No drain tummy tuck is the only dramatic change that has had a significant impact on the patient’s perception of the recovery and results in recent memory.

In some select cases, drains do need to be placed to reduce the chance of certain complications. Patients should schedule a consultation with a board certified Plastic Surgeon to see if they are a viable candidate for the no drain procedure.

Written by Cosmetic Town Editorial Team – MA

Based on an exclusive interview with Steven Vath, MD in Denver, CO