Abdominoplasty – The Recovery – The Way I Do It Now…
No Drains – No tubes – No Binders – No gauze dressings!
The following is a bit lengthy, but you can skip Abdominoplasty – The Recovery – The Way It is Usually Done… describing how the recovery from abdominoplasty typically is in most other practices if you are in a hurry. If you do have the time, I believe it is very important that you understand your options before going forward with this type of surgery. There is a lot of information presented below, but it is to your advantage to take a few minutes (maybe more than a few) to read this. It is important to compare the recovery I describe below to the way the recovery usually is (Abdominoplasty – The Recovery – The Way It is Usually Done…).
NOTE: The following does not apply to 4D VASER lipoabdominoplasty (abdominoplasty with VASER liposuction of the abdominal skin flap and flanks). For this procedure, there is a separate protocol that does include the use of a drain for about one week and a special customized garment (not a binder) for 4 – 6 weeks to get the maximum result.
- Suture - I use dissolvable sutures in multiple layers. They do not need to be removed.
- Dressings - DERMABOND™ PRINEO™ Skin Closure System - a half inch wide thin mesh tape impregnated with Dermabond tissue glue covers the wound. It is waterproof and feels like nothing at all. In two to three weeks it is painlessly peeled off the skin.
- Showering - You shower the next day after surgery. (no baths for three weeks, sitting in stagnant water may increase the risk for infection)
- Binder - I don’t use them. Got rid of them about ten years ago. I don’t believe they do anything positive but can cause problems with circulation to the abdominal skin flap and swelling. I can’t think of a single instance where I wished I used one but didn’t.
- Drains - In September, 2011 I stopped using drains. Where does the fluid go? It doesn’t go anywhere because using new techniques for this procedure I have drastically reduced the production of fluid in the first place! The little amount of fluid the body makes is also absorbed by the body. Does fluid ever accumulate? It does, but far less commonly than when I used drains. When I used drains, and I left them in for plenty of time (sometimes as much as 2 or 3 weeks), many patients would then begin to accumulate fluid after the drains were removed. So my conclusion, less problems with fluid accumulation without drains than with them.
- Pain medicine - This part is worth reading. If you read nothing else, read this. As I stated above (if you read the first part, if you didn’t go back and do so now), narcotic pain medicine causes nausea, vomiting, slows bowel function causing constipation, makes you sleepy, inhibits your return to activities and you should not drive or operate heavy machinery while taking them (who operates heavy machinery after a tummy tuck- but that’s what it says on the label on the pill bottle). What if we could eliminate or at least dramatically reduce the need for narcotic pain medicine?
- Hospitalization - my patients do not need to stay overnight in the hospital in the vast majority of cases (except circumferential abdominoplasties as I stated earlier). I prefer my patients stay at a nearby hotel located one mile from my office. A family member stays with them and I see them with my nurse at the hotel the following morning. If you prefer, I have nurses available to stay with you. After I see you in the morning, you are free to return home.
In 2002, I began using a device called an On-Q pain pump. It basically looks like a drain, a small rubber reservoir that contained marcaine, a local anesthetic which is automatically pumped into the body through two thin tubes that enter the abdominal skin and lie inside you betwen the abdominal skin above and the abdominal wall below. A local anesthetic is medicine that numbs you, like what the dentist uses. It puts pain nerves in the wound to sleep, unlike narcotic pain medicine that works on your brain to block pain impulses from nerves in the wound from reaching your brain. Anesthetics like marcaine are not associated with nausea, vomiting and constipation the way narcotics are. So my patients had this little device with two tubes entering their skin delivering the marcaine and they were pretty comfortable. They didn’t need much pain medicine, not nearly as much as before when I didn’t use the pain pump. Four days after surgery, the patient or a family member would painlessly remove the tubes from the body (they slid out very easily, unlike drains). There does exist a risk that the catheter (tube) from the pain pump can get stuck in the wound and not slide out – if this should happen then the patient needs to be returned back to the operating room to remove the tube!
BUT WHAT IF WE COULD GET RID OF THE PUMP???
In mid 2012 a revolutionary new drug hit the market. It is called Exparel. Exparel is basically marcaine. What’s so revolutionary about it? Marcaine lasts for about four to eight hours, not nearly long enough to give adequate postoperative pain relief. However, using cutting edge technology, a drug delivery system was created where the marcaine is slowly released over a period of about 72 – 96 hours. This dramatically extends the duration of action. Now it lasts about as long as when marcaine was used in the pain pump. The difference here is that the Exparel is injected like any local anesthetic directly into the surgical wound at surgery before the wounds are closed. There is no pump, there are no tubes. My patients are far more comfortable when they wake up from surgery after using Exparel then when I used the pain pump. They leave my surgical facility comfortable and have a very easy first night. I have also noticed that the amount of narcotic pain pills taken is significantly less than when I used the pain pump! It is not unusual for a patient to take no more than one or two pain pills after surgery! Want to buy some pain pumps? I have a whole bunch in my supply closet!
THE WAY I PERFORM ABDOMINOPLASTIES NOW…
- No bulky gauze dressings
- No drains
- No pain pumps and tubes
- Far, far less “discomfort”
- Immediate Ambulation
- No hospitalization
- Shower the next morning
No hassles, no wounds to take care of, no dressings to change, no drains to record, declog or clean, quicker recovery, less discomfort.
Now here’s the sad part. Many surgeons performing abdominoplasty are still using bulky dressings, drains, binders and narcotic pain medicine!