Why I Perform No-drain-Tummy Tucks !!
Abdominoplasties are most commonly called Tummy Tucks, abdominoplasties have become one of the most common procedures that I perform. Yes, they are usually accompanied with liposuction of the sides, hip roles, back and even inner and out thighs, and even breast augmentation – the combination of breast and abdomen restoration commonly called Mommy Makeover.
However, this discussion is solely about the Tummy Tuck, because of its prolonged recovery time, drains left in for usually five to seven days, and the high complication rate.
For the last three years drains have been eliminated in the almost all of my abdominoplasty patients. This is not a matter of simply deciding to leave them out. Steps must be taken during the surgery to allow one to eliminate the drains safely.
The patient must be off any anti-coagulants for generally three weeks prior to the surgery: this means aspirin. Omega-3, flax seed supplements, Advil, Motrin, Advil, Vitamin E, herbs, and anything that contains vitamin E, such as diet or nutritional drinks.
A special suturing technique used in Tummy Tuck surgery called Progressive Tension Sutures is also critical to eliminating the drains. When the flap of skin and subcutaneous fat is elevated from the abdominal wall muscles, a “dead space” has been created. Generally this space is left open allowing the skin and its underlying fat to slide around on the underlying muscles. This is bad. The technique to eliminate the drains is to suture the elevated skin and subcutaneous fat to the underlying fascia of the muscles, so it cannot slide around and shear, and this also closes the “Dead Space.”
The incidence of seromas (an accumulation of fluid) varies from 10% to 20% with other techniques even with drains.
My incidence of seromas for the last three years is zero, which doesn’t mean one can’t occur, but it still is a very good indication of the effectiveness of the technique. In addition, patient mobilization is faster, and the recovery time has been much shorter with less swelling.
I attended a presentation by the originators of the technique, Dr. Pollock and his son,
Dr. Pollock, recently, and their incidence of seromas in 900 patients was zero. Seromas are a complication that can be devastating to the patient with prolonged recovery times sometimes requiring further surgery. Reducing this risk while also reducing the discomfort of drains has been a significant improvement in Tummy Tuck surgery.
