Drain or no drain with tummy tuck?
The drainless tummy tuck seems to have been gaining recognition recently, but is it for real? Certainly having drain tubes after surgery is not something patients look forward to, but if it helps speed recovery and prevent complications then it is an acceptable trade-off.
Progressive Tension Sutures are key to the drainless tummy tuck
The no-drain tummy tuck is based on the technique of progressive tension sutures, which are internal stitches that hold the skin down instead of relying only on the stitches at the edge. I hit on the idea about 20 years ago, originally to try and pull the flap farther down for a lower scar and more tightening, without putting so much tension on the closure that it could end up widening the scar. That is why the technique is called progressive tension: each stitch pulls the flap a little farther down and distributes the tension evenly.
Evolution of the drainless tummy tuck
What I didn't know is that a colleague named Harlan Pollock in Texas was doing the same thing, and he is the one who named it the progressive tension suture method (PTS). What both of us noticed is that the amount of fluid output in the drains was greatly diminished. Dr. Pollock took it so far as to eliminate the drains altogether, thereby inventing the drainless tummy tuck. My technique evolved a bit differently, however, as I began more aggressively removing the fat layer on the deeper surface of the flap. I believe this allows for better contouring. I also am not hesitant to do liposuction in the waistline area adjacent to the tummy tuck, but these two things seem to cause just enough fluid to require a drain even with the PTS technique. The drains still come out much earlier than without PTS.
The ideal patient for the drainless tummy tuck then is one without much excess fat to be removed, at least the way I see it. Since even a small amount of fluid accumulation can affect the outcome if not prevented, I still use a drain most of the time.