Let’s take a minute to go through the way your body heals.  That will help to explain why some doctors use drains for tummy tuck patients.

The Healing Process

You’re excited about getting a tummy tuck so you probably don’t think about your tummy tuck recovery as your body “healing a wound”.  However, that’s exactly what happens during your recovery period. Your body doesn’t differentiate between the healing of an elective surgery or an accidental injury.  Any kind of wound healing has the same general stages. When it comes to your tummy tuck, one of the most important parts of the healing process is the inflammation stage.

Inflammation

During the inflammation stage, your immune system sends white blood cells to your wound to attack and destroy any bacteria, damaged tissues, or foreign materials that might be present. In the case of your tummy tuck, inflammation is your body’s response to your tissue being moved around during surgery, which your body registers as tissue damage.¹

One aspect of inflammation is fluid accumulation, which is a normal part of healing, and usually harmless. This fluid contains white blood cells, adequate blood flow, and a number of other components including lymph, to enable your tissues to heal properly. Fro example, when you get a scrape on your knee, there is a small amount of fluid under the scab. In the case of a small scrape, that fluid is helpful, but, in the case of your tummy tuck, too much of that pooled fluid can cause you some problems.

Tummy Tuck and Fluid

Before your tummy tuck, your skin, fat, fascia, and muscle are all tightly adhered to each other. There’s no air or space between the different tissue layers, and there’s no injury for your body to heal, which means there’s no extra fluid in your tissues.

After your tummy tuck, your entire belly has been worked on, and your body needs to heal from what it registers as an injury, so there is an excess amount of fluid being made by your belly’s tissues.  The surgical process also leads to a space between your fat layer and your muscle layer. This space has the potential to accumulate whatever fluid is building to help with healing. This can lead to what is called a seroma.

Seroma

A seroma is a collection of fluid in your tissues. If it’s a small seroma, you might not notice it.  If it is a larger seroma, it could feel like an uncomfortable pressure in your lower belly. You may feel a jiggly, “water balloon” sensation.  A seroma is usually located in your lower belly or pubic area because fluid falls with gravity, and this is the most gravity-dependent position in your belly. However, it is also possible to develop a seroma in your upper belly or elsewhere.

Most of the time, seromas do not lead to anything harmful.  In rare cases, your body can “wall off” a seroma, which can lead to fluid accumulating for weeks.  This situation could require another surgical procedure to remove the “walls” of the seroma. Another rare complication is that a seroma can become infected.²

How are seromas treated?

If your surgeon feels that you have a seroma, they will try to suck out the fluid by inserting a needle and pulling the excess fluid out into a syringe.³ This process is called “aspiration” of fluid.  Usually, your belly skin is numb after surgery, so putting the needle through the skin is often painless.  However, this process may feel somewhat uncomfortable, especially the first time.

Imagine that your body is like a bed.  You have a fitted sheet on the bottom and a flat sheet on top.  When the space between the sheets is loose, fluid can collect between the sheets. Your goal is to glue the fitted sheet and top sheet together, so there is no space for the fluid to collect. So, after the fluid is aspirated, it is very important to use your compression garment to squeeze that space shut. Also, avoid any unnecessary or strenuous activity.  The more active you are, the more fluid your body tends to produce.

How often will you need to be aspirated?

It depends on the person.  If you are really accumulating a lot of fluid, you may need to be aspirated every few days to avoid that uncomfortable pressure. For most people, though, once a week aspiration is enough.

How long will I need to keep aspirating the seroma?

Again, it depends on the person. Some people’s bodies keep producing fluid for weeks or months.  For others, it will only last a week or two. As your body produces less and less fluid, the seroma will shrink.  Eventually, it should go away completely.

I don’t want to get a seroma.  How can I avoid it?

Surgical drains were designed to eliminate spaces left behind after tissue manipulation in surgery. Typically, a drain relies on some sort of suction, which removes the extra fluid that can accumulate between your tissues.⁴  It also helps “glue together” the post-surgical space so that there isn’t room for fluid to build up in the first place. Typically, after your tummy tuck, you will probably have a drain on each side of your belly, to remove fluid from both sides.⁵

What are drains?

There are several different kinds of surgical drains, but the ones your surgeon uses for your tummy tuck are probably what are called “suction drains”. Suction drains use negative pressure to remove fluid.

One commonly used suction drain is the “Jackson Pratt” (or, “JP”) drain, which has several components. There is a white tube with holes in it that stays in the surgical wound, there is a part of the tube that is clear and comes out of your body, and there is a collection device at the end. The collection device is an oblong bulb that is squeezed, connected to the tube, and then is released to expand. That creates suction within the collection device, which sucks out the fluid from between your belly tissues.

Are There Any Problems Associated With Drains?

The most common thing that patients dislike about drains is that they are uncomfortable.⁶

They can tug and pull at your pubis area which can feel tender and sensitive. It can be a nuisance to have a tube dangling out of your body. Also, because they connect your insides with the outside world, they could contribute to infection. You might also need to have them in for a longer time than you or your surgeon were anticipating, depending on the amount of fluid that your body is making.

How Long Will I Need Drains After My Tummy Tuck?

How long you have your drains in depends on your fluid output. Usually, your first drain can be removed within two weeks from your tummy tuck. However, your second drain is typically left in until the fluid being drained is less than about 30 mL per day for 24 hours. That’s a common rule of thumb, but your surgeon may have other criteria.

You should use a drain log to track your drainage. The amount and rate of fluid drainage varies from person to person, so someone else might have theirs taken out within two weeks, and you might have yours out in four.  It all depends on the person.

Listen To Your Surgeon

If your plastic surgeon uses drains after your tummy tuck, it is a precaution to help avoid seroma. So, even if you might want them taken out early, they’re there to help you heal properly, so leave them in until your doctor says they’re ready to come out.

It may be possible to have your tummy tuck without using drains but remember that this may increase the risk of you developing a seroma. Ask your surgeon for more information.

1. Martin, Paul. “Wound healing–aiming for perfect skin regeneration.” Science 276, no. 5309 (1997): 75-81.
2. Seretis, Konstantinos, Dimitrios Goulis, Efterpi C. Demiri, and Efstathios G. Lykoudis. “Prevention of seroma formation following abdominoplasty: a systematic review and meta-analysis.” Aesthetic Surgery Journal 37, no. 3 (2017): 316-323.
3. Vidal, Pedro, Juan Enrique Berner, and Patrick A. Will. “Managing Complications in Abdominoplasty: A Literature Review.” Archives of Plastic Surgery 44, no. 5 (2017): 457-468.
4. Bercial, Marcos Eduardo, Miguel Sabino Neto, José Augusto Calil, Luis Antonio Rossetto, and Lydia Masako Ferreira. “Suction drains, quilting sutures, and fibrin sealant in the prevention of seroma formation in abdominoplasty: which is the best strategy?.” Aesthetic Plastic Surgery 36, no. 2 (2012): 370-373.
5. Vidal, Pedro, Juan Enrique Berner, and Patrick A. Will. “Managing Complications in Abdominoplasty: A Literature Review.” Archives of Plastic Surgery 44, no. 5 (2017): 457-468.
6. Seretis, Konstantinos, Dimitrios Goulis, Efterpi C. Demiri, and Efstathios G. Lykoudis. “Prevention of seroma formation following abdominoplasty: a systematic review and meta-analysis.” Aesthetic Surgery Journal 37, no. 3 (2017): 316-323.