Do drains or progressive tension sutures reduce seroma after abdominoplasty?

After abdominoplasty, fluid can collect in the space between the abdominal flap and the underlying tissues. This collection is called a seroma. Surgeons commonly use closed-suction drains, progressive-tension sutures (PTS), or both to manage this space. The evidence does not establish one approach as suitable for every patient: studies differ in their operations, definitions of seroma, follow-up and patient selection.

This review examines what comparative research says about drains and PTS, how investigators measured fluid collections, and what the findings can—and cannot—tell someone considering abdominoplasty. It is research information, not an individual treatment recommendation.

Why seroma prevention is studied

Abdominoplasty involves raising and redraping a broad abdominal tissue flap. Disruption of small lymphatic and vascular channels, residual space beneath the flap and movement between tissue surfaces may contribute to postoperative fluid accumulation. A clinically relevant collection can require assessment or aspiration and may complicate wound healing. Published studies also detect fluid by ultrasound, including collections that may not cause symptoms, so reported “seroma rates” are not automatically comparable.

A closed-suction drain removes fluid through a tube connected to a reservoir. PTS are sutures placed between the underside of the flap and deeper tissue in a sequence, bringing the surfaces closer together, reducing residual space and limiting shear. The proposed mechanism is mechanical; it does not mean that fluid formation is impossible. Surgeons vary in suture material, number and spacing, drain use, dissection, liposuction and postoperative care.

How the 2024 review was conducted

Rao and colleagues registered a protocol (PROSPERO CRD42022346106) and searched MEDLINE, Embase, CENTRAL, Google Scholar and Web of Science from 19 September 2022 to 19 February 2024, without language restrictions. Two authors screened records and assessed eligible full texts; four independently extracted study data. Randomised trials were assessed with RoB 2 and observational studies with ROBINS-I. They pooled eligible outcomes using random-effects models and reported risk ratios (RRs) with 95% confidence intervals (CIs). The abstract reports 24 studies, 750 patients and two randomised controlled trials. However, the full-text Search and Included Studies section reports 24 studies with 4,777 participants and three RCTs; it also lists 2,817 PTS-only, 1,065 drains-only and 1,346 combined-treatment participants, figures that total 5,228. These abstract and full-text counts conflict and cannot be reconciled from the report, so no overall participant or RCT total is treated here as confirmed. Separately, 24 studies reported a seroma outcome, while only eight comparative studies contribute to the principal PTS-versus-drains forest plot.^[1]

What the 2024 review found

For postoperative seroma, the review reported a pooled estimate favouring PTS over conventional drains: RR 0.34 (95% CI 0.15–0.76). The publication reports a relative effect, not an absolute patient probability; it does not mean a 66 percentage-point reduction. Baseline risk varies between patients and settings. Interpretation is limited by differences in patient selection, operative methods and seroma detection, alongside the small direct-comparison set and risk of bias.

The review did not find statistically significant differences between PTS and drains in haematoma, infection or wound separation (dehiscence). This is not proof that the approaches are equivalent. For PTS plus drains compared with PTS alone, the paper reports no significant seroma difference (RR 0.70, 95% CI 0.31–1.60). The estimate is imprecise and does not establish that drains are unnecessary for any individual.

The abstract’s liposuction subgroup statistics are not carried forward as a settled estimate: its seroma RR is paired with an exceptionally wide confidence interval and the reported significance value does not appear compatible with that interval. This internal reporting inconsistency means the subgroup should not be used to claim that liposuction plus PTS is superior.

A randomised trial illustrates the measurement problem

Andrades and colleagues conducted a prospective, randomised, double-blind trial in 60 women undergoing classic abdominoplasty. Participants were allocated to four groups: neither drains nor PTS, PTS alone, drains alone, or both. Drains remained for seven days in the groups assigned to drainage. Blinded evaluators assessed participants clinically and by ultrasound at two weeks; investigators also measured aspirations, aspirated volumes, non-seroma complications and aesthetic outcomes after follow-up. The accessible PubMed record is an abstract, so further protocol details and numerical group-level estimates were not available for independent checking here.^[2]

The abstract reports clinical seroma in 35% and ultrasound-detected seroma in 90% overall, with no significant frequency difference between groups. These are different detection measures, not contradictory estimates of the same endpoint: ultrasound identified many more collections than clinical examination. The control arm without either intervention was stopped after 10 participants because larger seromas and more aspirations were observed. That early stopping leaves a very small control group and can make comparisons unstable. The study also found that PTS increased operating time by 50 minutes in the relevant groups and reduced drain output when added to drains. Its authors proposed that PTS may compartmentalise fluid collections and facilitate absorption; this is a proposed explanation, not a guarantee.

How earlier reviews fit the evidence

Li and Wang’s 2021 systematic review included five studies (one randomised trial and four retrospective studies), totalling 1,255 adults. It searched PubMed, Embase and Cochrane databases and used a random-effects Mantel–Haenszel model. PTS without drains compared with drains alone was associated with lower seroma odds (OR 0.36, 95% CI 0.19–0.70; P = 0.002; I² = 9%). In the subgroup combining liposuction, the estimate was OR 0.24 (95% CI 0.11–0.49; P = 0.0001). However, PTS alone versus PTS plus drains showed no significant difference (OR 1.03, 95% CI 0.30–3.54; P = 0.96). The authors called for larger trials with better comparability. These odds ratios come from a smaller, earlier evidence set and should not be numerically blended with the later review’s risk ratios; reviews may also reuse some primary studies.^[3]

Liao and colleagues’ 2024 review asked a broader question about seroma-prevention methods. Its 20 studies included 1,205 patients overall, with follow-up ranging from two weeks to 20 months; a separate pooled analysis contained 203 unique patients. For PTS and quilting sutures together, an event ratio of 0.306 was calculated across study-specific comparisons, with four of five studies showing a qualitative benefit. That event ratio is not the same as the direct meta-analysis: three studies pooled for PTS/quilting sutures versus drains gave RR 0.29 (95% CI 0.05–1.66; I² = 74%), an imprecise interval that includes no difference. A separate overall pooled analysis combining several alternative techniques versus two drains gave RR 0.33 (95% CI 0.11–0.99; I² = 57%); it cannot be attributed to PTS alone. The review noted small samples, varied techniques and outcome definitions, and limited formal power calculations, and recommended standardised randomised comparisons.^[4]

What a patient can reasonably take from this

Current comparative evidence suggests that PTS may reduce seroma occurrence relative to drains in some abdominoplasty settings. It does not settle whether drains should be used for a particular person, whether a drain-free operation is appropriate, or whether one surgeon’s protocol is better. The evidence is limited by the small number of randomised studies, retrospective data, variation in PTS technique and drain practice, different definitions and detection methods, and differences in accompanying procedures and aftercare. Results from ultrasound-defined collections cannot automatically be equated with symptomatic collections requiring treatment.

A discussion with the treating surgeon can cover how they define and detect seroma; what approach they use and why; whether drains, PTS or both are planned; how personal health factors and the exact operation affect that choice; what follow-up and access to assessment are arranged; and what would happen if a collection develops. No technique can promise that seroma, aspiration, infection, wound problems or further treatment will not occur.

For general price planning, the tummy tuck cost in Turkey page outlines the commercial context; it cannot predict an individual quote or clinical plan. For questions about listed package information, consult the abdominoplasty package information and confirm any care, follow-up and arrangements directly with the relevant provider. The listing does not establish which surgical technique is included or clinically appropriate. Just Clinic Istanbul is an independent marketing and lead-generation platform, not a healthcare provider or medical tourism intermediary. Enquiries may be shared with authorised healthcare partners with your consent.

References

1. Rao G, Daneshi K, Ceccaroni A, Gentile A, El-Shazali H, Owens N, Vyas K, Khajuria A. A Systematic Review and Meta-Analysis Evaluating the Surgical Outcomes of Progressive Tension Suturing Compared to Drains in Abdominoplasty Surgery. Aesthetic Surgery Journal. 2025;45(1):71–83. Published online 30 July 2024; corrected and typeset 2 September 2024. doi: 10.1093/asj/sjae171. PMID: 39078654. PMCID: PMC11634385.
2. Andrades P, Prado A, Danilla S, Guerra C, Benitez S, Sepulveda S, Sciarraffia C, De Carolis V. Progressive tension sutures in the prevention of postabdominoplasty seroma: a prospective, randomized, double-blind clinical trial. Plastic and Reconstructive Surgery. 2007;120(4):935–946; discussion 947–951. Published 15 September 2007. doi: 10.1097/01.prs.0000253445.76991.de. PMID: 17805122.
3. Li M, Wang K. Efficacy of Progressive Tension Sutures without Drains in Reducing Seroma Rates of Abdominoplasty: A Systematic Review and Meta-Analysis. Aesthetic Plastic Surgery. 2021;45(2):581–588. Published online 27 August 2020. doi: 10.1007/s00266-020-01913-w. PMID: 32856104.
4. Liao CD, Zhao K, Nikkhahmanesh N, Bui DT. Decreasing Seroma Incidence Following Abdominoplasty: A Systematic Review and Meta-Analysis of High-Quality Evidence. Aesthetic Surgery Journal Open Forum. 2024;6:ojae016. Published 16 March 2024. doi: 10.1093/asjof/ojae016. PMID: 38585023. PMCID: PMC10995621.