Posts Tagged drains
Tummy Tuck surgery is almost invariably greatly appreciated by the proper patient. These top ten facts might help you figure if you are such a person.
(1) Tummy Tuck surgery is one of the largest scale operations a plastic surgeon can offer a patient.
(2) Patients who have lost a good deal of weight or completed child bearing involving large weight gain and loss are the most common candidates. Patients do not lose much weight from the operation itself in most cases….maybe a few pounds on average.
(3) Post-operative pain used to make it necessary to admit the patient to a hospital for narcotics.
(4) Pain pumps when properly utilized can decrease pain significantly. Overnight stays often reduce risk when properly supervised.
(5) Revisions are not uncommon but can often be done in a lower key environment….such as local in the office. The revision rate varies enormously between surgeons.
(6) All tummy tucks are not alike. The work of the novice really shows in this operation.
(7) Many physicians in the OC offer these operations including plastic surgeons, cosmetic surgeons, gynecologists and general surgeons. You guess which ones look the best?
(8) When you go to the bargain basement doctor, some of what may happen may not be correctable later.
(9) Drains and pump catheters will need to be used for a week or longer. They reduce risk of fluid collections that can ruin otherwise nice results (My opinion of course.)
(10) Smoking can really impair healing and lead to skin necrosis which commonly detracts from the quality of the result and delays wound healing sometimes for months. Don’t have the surgery if you can’t stop the cigarettes and tell your surgeon a true indication of how many cigarettes you are smoking daily.
John Di Saia, M.D.
Originally posted 2011-04-20 07:30:15.
Plastic surgery goes through periods in which things are fashionable and then not long later unfashionable. Some developments are presented as “epic” as if plastic surgery as a science and art steps forward with their introduction. Suffice it to say, the “hype factor” can be huge in plastic surgery.
I do a fair number of tummy tuck operations and have for quite a few years. My results are very good and my patients have greatly reduced discomfort from those I did even ten years ago. Much of this is due to my technique of pain pump placement. I modified that which I have been taught and it works very well.
On the issue of drains I am old school. My seroma rate (fluid collection rate) after tummy tuck surgery has been very very low for years. This is one of the reasons I am not a fan of the “no drains” progressive tension suturing technique that has become popular in some circles.
Drains are an inconvenience, but with the addition of pain pumps are more needed than ever before. The pain pumps also make them much less uncomfortable than they were a decade ago.
John Di Saia MD
Originally posted 2011-05-13 07:30:11.
I understand you recommend drains with tummy tuck surgery. How long must I keep those grenades of discomfort if you do my surgery?
Drains are a safety feature in tummy tuck surgery. They allow removal of fluid that would otherwise accumulate and potentially ruin the result. When you read of people complaining of “swell hell” after tummy tuck surgery for months at a time, this may be due to the ineffectual use of drains or the decision not to use them at all. Sometimes fluid collections can become inundated with scar tissue (an organized seroma) that can persist permanently. I believe these can be minimized by the proper use of drains. They have been in my practice.
There are newer (and in my opinion foolish) techniques that purportedly allow tummy tuck surgery to be done without the use of drains. Progressive Tension Suturing is a very modern sounding term, but one that in my opinion leads to the potential for inferior results. Remember, my blog…my opinion.
If you would like to reduce the potential for swell hell, my general advice is to not have lipo in the flanks or abdomen with your tummy tuck and have drains put in and left in until they no longer drain much fluid. Also have a good compression garment placed and wear it religiously.
On your question, my wife had an extended tummy tuck without flank lipo. Her drains drained next to nothing by 12 days and were removed by that time. Her swelling has been minimal since. No swell hell for her. She was still wearing her compression garment a month later as a prophylactic, but at six weeks discontinued it without a problem.
John Di Saia MD
2 days out from her Tummy Tuck, Kim is doing well. She talks about her pain control, drains and state of living in the days following surgery. She is getting ready to maybe leave the bedroom for a trip to the kitchen, but not anywhere near ready to leave the house yet. We demonstrate how she empties her drain bulbs to remove the fluids that would otherwise accumulate in the wound and potentially ruin the outcome.
John Di Saia MD
Five hours after her tummy tuck, Kim’s condition is a credit to modern pain pump design and placement. She is awake and taking relatively little pain medication at home 5 hours after a large scale tummy tuck with a muscle repair. Before pain pump development, she would have been much more uncomfortable in a hospital bed during this same post-operative period taking intravenous narcotics. She updates you on her medications, pain and drains.
John Di Saia MD
Believe it or not, a major source of pre-operative dismay with tummy tuck patients is on the issue of drains.
Tummy Tuck patients need drains. Drains help decrease the potential for seroma formation (fluid collecting between the skin flap and muscle). Seromas can really make post-operative care difficult especially if they become infected. The judicious use of drains really decreases the potential for seromas.
Personally, I use drains until fluid output pretty much ceases. This is usually 1-2 weeks. Larger cases/patients can require them longer. Other surgeons don’t use them or remove them sooner and tolerate a higher risk of seromas. This is a matter of opinion. Their patients seem to end up with less flattened tummies than mine. I do what I do with reason.
Here is an close-up of one of my tummy tuck patients five days from her surgery. The drains are the tubes leading to the larger bulbs at her sides. The thinner tube toward the center is her pain pump catheter.
The drains really don’t cause much discomfort although they are unsightly and patients usually are relieved when they are removed.
John Di Saia MD
Originally posted 2005-05-12 21:20:00.