Tummy tuck without drains
Our work on no drain tummy tuck was awarded the ‘best presentation’ at the Scottish Meeting of Plastic Surgeons in 2013 and has been published in the world’s leading plastic surgery journal – Plastic Reconstructive Surgery in 2015. Awf Quaba was invited to discuss our technique and results in October 2018 at the annual meeting of the British Association of Aesthetic Plastic Surgeons (BAAPS) – Abdominoplasty to drain or not to drain?
We looked at all tummy tucks performed in our practice over ten years and assessed the outcomes, focussing on our risks and complications and the need for revisions.
Standard tummy tuck
Most surgeons in the UK use drains during a tummy tuck procedure, and these can remain in place from anything from 1 day to 5 days. The logic behind using drains is to reduce the risk of blood and fluid collecting under the skin. Drains can be uncomfortable for patients and limit mobility. They can delay the time a patient has to stay in the hospital. There is little evidence for their use in the published literature.
We looked at 271 patients over a ten year period who had a tummy tuck in our practice. None of the patients had drains as we use a modified technique that we believe limits the risk of bleeding and seroma (fluid collection within the abdomen that is one of the most common side effects of a tummy tuck).
These were some of our findings:
The average age of a patient having a tummy tuck in our practice: 45 years old (range from 20 years to over 60 years)
Average number of previous pregnancies: 2.4 pregnancies
60% of patients had scars on their abdomens from pasts surgery (mostly caesarian sections or hysterectomies)
61% of patients had liposuction of their bellies combined with a tummy tuck
47% of patients had other cosmetic procedures at the same time as their tummy tuck (most frequent other operation was a breast augmentation/ or breast lift)
Our complication rates:
1.8% of patients had bleeding after surgery which required them to go back to the theatre to stop the bleeding. This outcome compares very favourably with other studies which used drains. Their bleeding rates that needed a return to the theatre were 0.9%, 3%, 2%, 3.8% and 6.8%.
Our seroma rate (which required draining using a needle in the outpatient department) was 7.7%. Again this compares very favourably with other published studies which used drains. The published seroma rates in these studies ranged from 4.5% to 19.2% with most having higher percentages than ourselves.
Our wound infection rate (infections which required treatment with antibiotics) was 4.5%. Again this compares favourably with other studies.
Our revision rates:
Our revision rate (patients needing a second procedure due to dissatisfaction with the first procedure) was 8.9%. This revision rate was lower than any other published series (range 11% to 34.4%). An extensive series published in the UK looked at the revision rates of a group of cosmetic surgeons in London and reported a revision rate of 24%.
Our inpatient stay:
On average our patients were in the hospital for 1.7 days. Again this was lower than most other published series bearing in mind that 47% of our patients had other cosmetic procedures carried out at the same time.
What is different about our technique?
Our tummy tuck is no different to a standard tummy tuck in its aim to remove excess skin and fat from the abdomen. The scars are the same (hip to hip), and the abdominal muscles are tightened in the same way when required. The difference is that we leave behind a thin layer of fat (subscarpa fat) over the abdominal wall. This layer of fat is thought to be rich in lymph draining channels that may be important in reducing seroma formation. The thin layer of fat left behind also reduces the amount of space (dead space) when the wounds are closed. Reducing dead space may be helpful in promoting healing and limiting the amount of fluid that can collect.
Our study has shown that tummy tucks can be carried out safely and with low complication rates if drains are not used. Not using drains means less discomfort for patients and earlier discharge from the hospital. We have demonstrated that patients leave the hospital within two days of having surgery (on average) and that our revision rate is low (8.9%)
Publication of our work
The no-drain, no-quilt abdominoplasty: a single-surgeon series of 271 patients.
Quaba AA, Conlin S, Quaba O.
Recent innovations in abdominoplasty include progressive tension “quilting” sutures or Scarpa fascia preservation to limit the risk of seromas and hematomas. No-drain abdominoplasty with progressive tension sutures has been well documented. The authors describe outcomes in patients undergoing abdominoplasty with a modified surgical technique (including sub-Scarpa fascia fat preservation) and no use of drains or progressive tension sutures-the “no-drain, no-quilt” abdominoplasty.
A retrospective, single-surgeon (A.A.Q.), single-site analysis of all abdominoplasty patients from 2003 to 2012 was performed. Data were extracted from paper case notes. All patients underwent surgery carried out under general anesthesia. The operative technique and postoperative regimen are described.
Two hundred seventy-one patients were identified over the 10-year period. Patients had a mean age of 45 years and mean body mass index of 27, and 98 percent were women. Concomitant abdominal liposuction was undertaken in 61 percent of all patients (165 of 271). Twenty-one patients (7.7 percent) had a seroma and five patients (1.8 percent) had a hematoma. Seven patients (2.6 percent) required a return to the operating room to manage complications, and 24 (8.9 percent) required elective revision. Patients were admitted for an average of 1.7 days, and mean follow-up was 6.2 months.
Abdominoplasty can be performed safely without drains or quilting sutures/progressive tension sutures. Benefits are discussed in terms of the potential for reduced intraoperative time (compared with progressive tension sutures), and reduced patient discomfort and inpatient stay (compared with drain use). The authors demonstrate low complication and elective revision rates in their series.
CLINICAL QUESTION/LEVEL OF EVIDENCE:
Author: Dr Omar Quaba, Consultant Plastic Surgeon, MBBChir, MA, FRCS (Plast)