In the process of performing an abdominoplasty, the skin and fat on the abdomen are elevated off of the underlying stomach muscles to allow tightening of both the muscles and the skin. As a result of this procedure, a large raw surface area on the abdominal wall is created where fluid such as blood and serum can accumulate. If this fluid is not removed, its presence can increase the risk of infection and seroma formation (a collection of blood without blood cells).
Removing these fluids before they can accumulate can reduce the risk of these complications occurring. This is accomplished by placing closed-suction silicone drains into the potential spaces where fluid is most likely to collect. These drains exit the skin through small openings which may or may not be along the surgical incision and are normally sutured in place so that they cannot be accidently pulled out.
The drainage tubes are about 3/16 of an inch in width and are attached to soft, semi-clear collection bulbs which have calibrations to help monitor how much fluid comes out. It is important to keep track of how much fluid exits from each drain as this is what determines when the drains are removed. In general, the first drain is taken out 3-4 days after surgery and the second is removed 3-4 days later; again, depending on how much fluid is coming out.
Following a tummy tuck, patients are placed in an abdominal binder which should be firmly but not tightly applied. This gentle pressure is also an effort to reduce the accumulation of fluid between the skin and muscles. This binder is generally worn for 3-4 weeks after surgery.
Reduced activity for the first 10-14 days after surgery in also encouraged to reduce the accumulation of fluid, however, frequent and early ambulation is always best to lower the risk of blood clots from forming in the legs.
Recently, there has been a push to decrease the need for the use of drains or at least reduce the amount of time that they are in. This has been accomplished by the use of plication sutures, which are absorbable stitches placed to hold the subcutaneous fat layer back down to the muscle surface. These serve the purpose of reducing the size of the potential dead space that was created by separating these two tissues in order to reposition the skin and to expose the muscles for the tightening sutures. Many progressive surgeons, including Dr. McMahan, generally choose to use both plication sutures as well as drains in an effort to do as much as possible to reduce complications such as seroma formation. A seroma is a collection of fluid in a pocket that consists of blood without blood cells. A seroma can increase the risk of infection, cause pain, reduce the final cosmetic result and it may need to be drained repeatedly; sometimes, reoperation may be necessary.