No Drain Abdominoplasty with Progressive Tension Suture: The Logic, Simplicity, and Aesthetics

  • Harlan PollockEmail author
  • Todd Alan Pollock


Traditional abdominoplasty techniques have been plagued with an unacceptably high seroma rate, and attempts to control seroma with drains and immobilization have only been marginally effective and poorly accepted by patients and can potentially lead to other complications. Progressive tension sutures are a simple adjunctive step that can be added to most abdominoplasty techniques that nearly eliminate seromas as well as the need of drains, immobilization, or tight compressive garments. The authors have used this suturing technique in abdominoplasty for over 40 years without drains and have seen near eradication of seromas. Many others have confirmed their effectiveness through studies of their own. This chapter explains the logic of the progressive tension sutures concept and describes technical details of our drain-free abdominoplasty technique utilizing these sutures. Benefits of PTS include reduced complications, especially seromas, and the improvement in the patient’s postsurgical experience related to upright ambulation, improved mobility, and especially the elimination of drains. Theoretical benefits like decreasing VTE risk and improved distal flap circulation have been observed clinically but await further scientific documentation.


Deep Fascia Superficial Fascia Abdominal Flap Secure Fixation Flap Elevation 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Pollock H, Pollock T. Progressive tension sutures: a technique to reduce local complications in abdominoplasty. Plast Reconstr Surg. 2000;105(7):2583–6.CrossRefPubMedGoogle Scholar
  2. 2.
    Pollock H, Pollock TA. Progressive tension sutures in abdominoplasty: a review of 597 consecutive cases. Aesthet Surg J. 2012;32(6):726–44.CrossRefGoogle Scholar
  3. 3.
    Pollock H, Pollock T. Subcutaneous browlift with precision suture fixation and advancement. Aesthet Surg J. 2007;27(4):388–95.CrossRefPubMedGoogle Scholar
  4. 4.
    Rios J, Pollock T, Adams W. Progressive tension sutures to prevent seroma formation after Latissimus Dorsi harvest. Plast Reconstr Surg. 2003;112(7):1179–83.CrossRefGoogle Scholar
  5. 5.
    Pollock H, Pollock T. Management of facelifts with progressive tension sutures. Aesthet Surg J. 2003;23(1):28–33.CrossRefPubMedGoogle Scholar
  6. 6.
    Baroudi R, Ferreira CA. Seroma: how to avoid it and how to treat it. Aesthet Surg J. 1998;18(6):439–41.CrossRefPubMedGoogle Scholar
  7. 7.
    Andrades P, Prado A, Danilla S, Guerra C, Benitez S, Sepulveda S, Sciarraffia C, De Carolis V. Progressive tension sutures in the prevention of the post-abdominoplasty seroma: a prospective, randomized, double-blinded clinical trial. Plast Reconstr Surg. 2007;120(4):935–46.CrossRefPubMedGoogle Scholar
  8. 8.
    Kahn S, Teotia SS, Mullis WF, Jacobs WE, Beasley ME, Smith KL, Eaves 3rd FF, Finical SJ, Watterson PA. Do progressive tensions sutures really decrease complications in abdominoplasty? Ann Plast Surg. 2006;56(1):14–21.CrossRefGoogle Scholar
  9. 9.
    Nahas FX. Does quilting sutures prevent seroma in abdominoplasty? Plast Reconstr Surg. 2007;119(3):1060–4.CrossRefPubMedGoogle Scholar
  10. 10.
    Antonetti JW, Antonetti AR. Reducing seroma in outpatient abdominoplasty: analysis of 516 consecutive cases. Aesthet Surg J. 2010;30(3):418–27.CrossRefPubMedGoogle Scholar
  11. 11.
    Trussler AP, Kurkjian JT, Hatef DA, Farkas JP, Rohrich RJ. Refinement in abdominoplasty: a critical outcomes analysis over a 20 year period. Plast Reconstr Surg. 2010;126(3):1063–74.CrossRefPubMedGoogle Scholar
  12. 12.
    Arantes HL, Rosique RG, Rosique MJ, Melega JM. The use of quilting sutures in abdominoplasty does not require aspiratory drainage for prevention of seroma. Aesthet Plast Surg. 2010;34(1):102–4.CrossRefGoogle Scholar
  13. 13.
    Warner JP, Gutowski KA. Abdominoplasty with progressive tension closure using a barbed suture technique. Aesthet Surg J. 2009;29(3):221–5.CrossRefPubMedGoogle Scholar
  14. 14.
    Rosen AD. Use of absorbable running barbed sutures and progressive tension technique in abdominoplasty: a novel approach. Plast Reconstr Surg. 2010;125(3):1024–7.CrossRefPubMedGoogle Scholar
  15. 15.
    Wiener T. Continuous running sutures: a modification of progressive tension abdominoplasty. Aesthet Surg J. 2012;32(2):248–9.CrossRefPubMedGoogle Scholar
  16. 16.
    Andrades P, Prado A. Composition of post-abdominoplasty seromas. Aesthet Plast Surg. 2007;31(5):515–8.CrossRefGoogle Scholar
  17. 17.
    Wall Jr S. SAFE circumferential liposuction with abdominoplasty. Clin Plast Surg. 2010;37(3):485–501.CrossRefPubMedGoogle Scholar
  18. 18.
    Caprini JA, Arcelus JI, Reyna JJ. Effective risk stratification of surgical and nonsurgical patients for venous thromboembolic disease. Semin Hematol. 2001;38(2 Suppl 5):12–9.CrossRefPubMedGoogle Scholar
  19. 19.
    Huang GJ, Bajaj AK, Gupta S, Petersen F, Miles DAG. Increased intra-abdominal pressure in abdominoplasty: delineation of risk factors. Plast Reconstr Surg. 2007;119(44):1319–25.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.North Dallas Plastic SurgeryDallasUSA
  2. 2.University of Texas, Southwestern Medical SchoolDallasUSA
  3. 3.Department of Plastic SurgeryUniversity of Texas SouthwesternDallasUSA

Personalised recommendations