E. Ronald Finger

Abdominoplasties are most commonly called “tummy tucks.” This surgery has become one of the most common procedures performed by plastic surgeons.

The procedure is usually accompanied with liposuction of the sides, hip rolls, back, inner and outer thighs, and even breast augmentation and-or breast lifts. (The combination of breast and abdomen restoration is commonly called a “Mommy Makeover.”)

The tummy tuck requires a prolonged recovery time, with drains usually left in for five to 10 days; it carries a high complication rate.

For several years, drains have been eliminated in tummy tuck procedures for many plastic surgeons. Choosing to eliminate drains is not a matter of simply deciding to leave drains out. Steps must be taken during the surgery to allow the elimination of the drains safely.

With tummy tucks, the excess skin and fat in the lower abdomen is excised and discarded. Then a special suturing technique, called “Progressive Tension Sutures,” is necessary for the drainless tummy tuck surgery. These sutures are critical to eliminating drains.

When the flap of skin and adjoining subcutaneous fat is elevated from the underlying abdominal wall muscles, an empty “dead space” has been created. Generally, this space was left open, allowing the skin and attached fat to slide around on the underlying muscles, promoting fluid accumulation.

Instead, Progressive Tension Sutures attach the elevated skin and subcutaneous fat to the underlying fascia of the muscles, eliminating the “dead space,” not allowing it to slide around and shear, thus no fluid accumulation.

The incidence of seromas (accumulation of fluid) varies from 5 percent to 25 percent with other techniques, even with drains. The most important aspect of the drainless tummy tuck procedure is eliminating the dead space with the Progressive Tension Sutures. However, with these sutures, drains are usually not necessary.

The originators of the technique, plastic surgeons Dr. Harlan Pollock and his son, Dr. Todd Pollock, presented a 900-case study several years ago. Their incidence of seromas in 900 patients was zero.

Seromas are a complication that can be devastating to patients with prolonged recovery times, sometimes requiring further surgery. Reducing this risk while also reducing the discomfort of drains has been a breakthrough in tummy tuck surgery.

Reducing the seroma risk to zero in several hundred cases doesn’t mean fluid accumulation cannot 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 is shorter with less swelling and discomfort.

Advances in cosmetic surgery continue to result in patient safety, shorter recovery time, less discomfort, and better outcomes. This should be encouraging for these contemplating such surgery.

E. Ronald Finger, MD, FACS is a board certified plastic surgeon with offices in Savannah and Bluffton. fingerandassociates.com