NO DRAINS – NO TUBES – NO BINDERS – NO GAUZE DRESSINGS!
The following is a bit lengthy, but if you are in a hurry, 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 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: This protocol applies to both abdominoplasties without liposuction as well as the 4D VASER/PAL lipoabdominoplasty (abdominoplasty with VASER/PAL liposuction of the abdominal skin flap and flanks). There are some minor differences which will be pointed out.
I use dissolvable sutures in multiple layers. There are no sutures to be removed.
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. I find that the scars look great, and more importantly, I believe that this type of dressing is not only much easier to take care of because you can shower over it and gauze dressings and tape are not required, but also the waterproof barrier is important in reducing the risk for infection.
You shower the next day after surgery. (no baths for three weeks, sitting in stagnant water may increase the risk for infection)
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.
I do find that a compression garment with moderate compression is very helpful to limit and control post operative swelling. Usually my patients wear them about six weeks, but this also depends upon how your are doing. While it might seem that this would be an issue for most patients, my patients actually like the feeling of support that the garments provide.
In September, 2011 I stopped using drains. Where does the fluid go? It doesn’t go anywhere because using new techniques for abdominoplasty 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. How is this possible? I use a suturing technique called “progressive tension sutures” that actually fix the underside of the abdominal skin flap to the abdominal wall muscles. After the skin flap is sutured down, the waist crease incision is closed. In traditional abdominoplasty, only the waist crease incision is closed, leaving a large potential space for fluid to accumulate and hence the need for drains. The video below demonstrates how this is performed.
My patients do not need to stay overnight in the hospital in the vast majority of cases (except occasionally after circumferential “belt” abdominoplasties as I stated earlier). I prefer my patients stay at a nearby hotel located one mile from my office. One of my surgical nurses who is intimately familiar with your surgical procedure will follow you from my office surgical facility to the local hotel and stay with you until the morning. She will be in touch with me during the night. My nurse will then get you ready for the trip to your home. Your family can then pick you up at the hotel and take you home. This gives your family caretaker a chance to get some rest before you come home and my nurse will be taking care of you the first night after surgery when you will require the greatest amount of care. Patients love this arrangement and I believe that it results in you obtaining the best possible level of care after your surgery.
This part is worth reading. If you read nothing else, read this. 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? You will read more on this below.
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 between 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). 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!
Exparel – The End 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 from microscopic “liposomes,” tiny granules containing molecules of the drug, over a period of about 72 – 96 hours. This dramatically extends the duration of action and relief of discomfort. 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!