The No Drain Tummy Tuck
The no drain tummy tuck, also called the progressive tension suture technique for Abdominoplasty, was developed by a father and son team of plastic surgeons who are colleagues of mine. I developed a modification of their technique that was published in the plastic surgery literature.
In the traditional technique of a tummy tuck, after the stretched muscle is repaired, the skin is pulled down, excess skin is removed, and the incision across the lower abdomen is closed. In this technique, all the tension of pulling the skin is at the suture line (which will end up being the scar). Because of this, it can cause a wide scar. It can also create a large space called a dead space where fluid can accumulate.
In the past, drains were used to remove this accumulated fluid. However, even using a drain does not guarantee a fluid collection will not occur. In the past, when I used drains I found this was true. In published plastic surgery literature, there is actually a higher incidence of fluid collections when using drains (as opposed to not using drains with the progressive tension suture technique).
The technique, to limit fluid accumulation, involves a series of sutures. These sutures, placed from the top to the bottom of the abdomen on the underside of the skin flap, help distribute tension across the entire flap. By the time I close the actual incision, there is minimal to no tension on the suture line (a better scar is achieved). The sutures also act like quilting sutures, and essentially suture the skin flap down to the muscle layer. This reduces or eliminates the dead space and there is less chance for the fluid to accumulate. In my opinion, this technique is the most significant advancement in tummy tuck surgery in the past 50 years.
I am a strong advocate for this technique. At the aesthetic surgery society meeting every year, I am an invited instructor with the surgeons who developed and teach this technique.