Abdominoplasty is one of the most commonly performed cosmetic surgical procedures. The operation involves the undermining of the abdominal skin, repositioning and removal of skin excess. It is an excellent means of rejuvenating the abdomen following pregnancy and weight loss.
Traditionally drains have been used to reduce the chance of hematoma and seroma. The treatment of seromas can be complex and involve multiple aspirations. Reduction of seroma rates is essential to improve long-term satisfaction for patients.
There is no evidence that drains prevent the incidence of seroma and surgical techniques may well be the key to decreasing the incidence of seroma.
Drains have been shown to increase hospital stays, limit mobilization, increase patient discomfort and are an additional source of infection.
A recent publication has highlighted the need to look at surgical technique rather than the use of drains to limit seromas. Preservation of the deep lymphatic vessels requires dissection in a superficial plane with preservation of thin layer of fascia, Scarpa fascia that exists within the abdominal fat. This is a distinct anatomical structure and although more difficult to identify for the inexperienced surgeon is a distinct entity. Preservation of this holds the key to reduction of seroma.
Mr. Ross uses the same described method of dissection for all his patients and has not used surgical drains for a number of years. Mr. Ross has not at the time of writing had a seroma using this method. Mr. Ross does not use drains and does not believe that there is any association between the use of drains and the prevention of seroma.
Mr. Ross almost always strengthens the abdominal wall and almost always recommends surgical garments. Mr. Ross mobilizes all patients immediately postoperatively and believes that garments provide patients additional support when mobilizing postoperatively.
Quaba AA1, Conlin S, Quaba O. The no-drain, no-quilt abdominoplasty: a single-surgeon series of 271 patients. Plast Reconstr Surg. 2015 Mar;135(3):751-60.