Before and four months after a tummy tuck with liposuction. Scars look best at one year post-op.

Abdominoplasties are most commonly called “tummy tucks,” and these are among the most common procedures performed by plastic surgeons. They are usually accompanied with liposuction of the sides, hip rolls, back, and even inner and outer thighs, and sometimes knees.

Tummy tucks have been associated with prolonged recovery time, discomfort, a high complication rate, and drains usually left in for five to 10 days, which most people profoundly dislike.

For the past several years, however, drains have been eliminated in tummy tuck procedures by many plastic surgeons. Choosing to eliminate drains is not a matter of simply deciding to do so. 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 is necessary for the drainless tummy tuck surgery called progressive tension sutures. These sutures are critical to eliminating drains.

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

Now, progressive tension sutures eliminate the “dead space,” thus not allowing skin and fat to slide around and shear, thus no fluid accumulation and more rapid healing.

The incidence of seromas varies from 5% to 25% 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, and not actually eliminating the drains themselves. However, with these sutures, drains are rarely necessary.

The originators of the technique, Dr. Harlan Pollock and his son Dr. Todd Pollock, both plastic surgeons, 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 vast improvement in tummy tuck surgery.

Reducing the seroma risk to zero in several hundred cases doesn’t mean fluid accumulation cannot occur, but it’s a very good indication of the effectiveness of the technique. In addition, patient mobilization is faster, and recovery time is shorter with less swelling and discomfort.

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