Abdominoplasty, often called a tummy tuck, remains a popular and effective choice in our cosmetic surgery practice for improving the appearance of a protruding, saggy midsection. Now Denver, CO, plastic surgeons Dr. Steven Vath and Dr. Andrew Wolfe are offering a variation on the traditional tummy tuck, which uses progressive tension sutures to eliminate the need for post-surgical drains during recovery.
Abdominoplasty is one of the most frequently performed plastic surgeries and is particularly popular among weight loss patients and women whose abdomens have been overtaxed by pregnancy. However, until recently, abdominoplasty has required that suction drains be left in place for several days after surgery to prevent seromas (fluid accumulation). These plastic drainage tubes are sutured to the skin causing marked discomfort and limiting patients’ mobility after surgery.
Issues With Surgical Drains
“There is no question that the surgical drains were the biggest cause of discomfort for most patients following abdominoplasty at our plastic surgery center,” say Dr. Vath and Dr. Wolfe. “The vast majority of calls we received from patients in the days following their abdominoplasty involved issues with their drains.” These issues include:
- Concerns about the drains becoming dislodged
- Pain or irritation at the drain site exiting the skin
- Limitations in movement and showering
In a traditional tummy tuck procedure, drains are used to prevent fluid accumulation in the “open space” created beneath the abdominal flap (skin and fat) and above the muscle. Through a fairly simple modification of the surgery—the use of progressive tension sutures—Dr. Vath and Dr. Wolfe can eliminate this space, as well as securely advance the flap with tension distributed over a broader area. “The addition of the sutures is an improvement to an already effective surgical procedure,” they report, adding, “Surgical time is marginally increased by 5 to 10 minutes, and the result is well worth it.”
Advantages of the Drainless Technique
The use of progressive tension sutures secures the abdominal flap to the underlying fascia, distributing tension over a larger area. This prevents seroma formation as there is no longer any space in which fluid can accumulate. Furthermore, with this technique, tension is spread out, rather than concentrated at the wound closure site. According to Dr. Vath and Dr. Wolfe, “Not only does this approach allow for the procedure to be done without drains, it decreases the risk of other complications associated with having most of the tension on the wound closure, such as hypertrophy of the scar.”
Dr. Vath and Dr. Wolfe have achieved excellent results through incorporating progressive tension sutures into their abdominoplasty procedures. There is mounting evidence within the plastic surgery research journals and at international meetings supporting this method of avoiding drain placement during tummy tucks. Since Dr. Vath and Dr. Wolfe have abandoned the use of drainage tubes, they have found no increased risk of seroma formation. Their patients report fewer post-operative concerns and are significantly more comfortable and mobile during the first week following their surgery.
According to Dr. Vath and Dr. Wolfe, only a small number of plastic surgeons nationwide are beginning to offer the no-drain abdominoplasty. However, they say that with results that are so overwhelmingly positive, this technique may become the standard for abdominoplasty in the years ahead.