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Seromas After Tummy Tuck - When Will I Get Better?

i had gastric bypass in 2009 and decied since i kept 200 pounds off i should habe tummy tuck to remove the skin., i had a tummy tuck september 5th 2012, and since then i have developed seromas and had two drains placed to try and get rid of fluid, iv also had two painful injections and still every time he has removed the drain i begin developing fluid. i feel i need to ask more about what to do and get a second doctors opinion. i am at wits end and i feel like i am never going to get rid of this or get better.

Doctor Answers (9)

Recalcitrant Seroma after TT

+2

  Recalcitrant seromas can be difficult to get rid of. It appears you have had the traditional treatments of aspiration, drain replacement and attempted sclerosis. I do not have good news for you. The options now are basically down to two. You can return to the OR and the seroma cavity can be excised, closed with progressive tension sutures and drained. Or your seroma can be exteriorized/ opened and a drain placed so, it comes out the open wound/ hole. You would then irrigate out the cavity and allow it to close secondarily. The penrose drain would slowly be advanced out as the seroma cavity closes. This usually takes about 3 to 4 weeks. Most patients choose the later method as there is no guarantee that the first method will not result in another seroma.
  There may be other issues that may explain your predicament/ condition such a low protein level, malnutrition, etc.. May I suggest you return to surgeon and discus you options. If you are not satisfied then, consider a second option with a member of the ASAPS. They are experts in corrective body contouring procedures. Best,

 

Gary R Culbertson, MD, FACS


Columbia Plastic Surgeon
5.0 out of 5 stars 3 reviews

Seroma and Tummy Tuck

+1
Thank you for your post. Seromas can be painful and cause a cosmetic deformity, as well as sometimes leak. The whole point of drains is to keep a seroma from happening in the first place. If a drainless procedure was performed, and you had a seroma, or you had drains that were pulled and you subsequently had a seroma, then you should be drained, otherwise a capsule builds around the fluid making it permanent. If a capsule builds around the seroma (pseudo bursa or encapsulated seroma) then the only way to remove the seroma is to surgically open the areas and excise the capsule, and close over drains to prevent another seroma from happening. If the seroma is encapsulated and is tight and painful, then it can be confused with just swelling or fat. An ultrasound is useful in distinguishing these and identifying the extent of the seroma. If the seroma is not yet encapsulated, then it is usually loose and has a 'fluid wave' or water bed type feel. Occasionally, a seroma can also become infected, especially if a permanent braided suture was used. This will have a hot, red appearance, and will eventually open up. I have never seen an infection from sterile aspiration of fluid.
Best wishes,
Pablo Prichard, MD

Pablo Prichard, MD
Phoenix Plastic Surgeon
5.0 out of 5 stars 26 reviews

Recurrent Seroma after Tummy Tuck

+1

  Recurrent seroma after tummy tuck can be drained multiple times. At this point, a sclerosing agent can be considered.  Ultimately, the seroma cavity may need to be excised.

Kenneth B. Hughes, MD
Los Angeles Plastic Surgeon
5.0 out of 5 stars 192 reviews

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Seromas After Tummy Tuck

+1

These can be difficult problems for patient and for surgeon. They are more common in massive weight loss patients. As the skin and fat shrink away, the blood vessels and the lymph channels often remain large, and it is the lymph channels that leak and cause this problem.

It sounds like you may have had some tries at sclerosis--simple aspiration should not have been painful If not, ask your surgeon. Various agents can be used--betadyne, , tetracylcline, alcohol, in an attempt to get the edtges to stick together and stop secreting fluid. If that was done it may be that a surgical procedure may be needed to remove the lining and reclose the abdomen.  This option also should be discussed with your surgeon.

Thanks for your question, best wishes. 

Jourdan Gottlieb, MD
Seattle Plastic Surgeon
4.5 out of 5 stars 30 reviews

Seroma in a weight loss patient.

+1

Thanks for your post. Seromas in patients after weight loss can be really challenging. In some cases, the drains have to left in for weeks. It sounds like you had 2 sclerosis attempts (painful injections) and both have failed. Seeking a second opinion is a good idea. You should seek out a board certified plastic surgeon who specializes in major weight loss body contouring. They are likely to have the most experience with difficult seromas. It sounds like your current surgeon did everything he/she could. The next step could be surgery. Best wishes, Dr. Aldo.

Aldo Guerra, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 125 reviews

Seroma

+1

The pocket needs to collapse and heal for the seroma to go away. This may take some time. Your surgeon is the best to address the problem

Norman Bakshandeh, MD, FACS
New York Plastic Surgeon
5.0 out of 5 stars 9 reviews

You may have a pseudo bursa

+1

Hello,

Thank you for the question.  It sounds like you have tried the conservative treatments for seroma treatment without success.  Your best option at this time is surgery to remove any scar tissue that has formed (pseudo bursa) as well as any other issues such as permanent sutures that may be creating inflammation.  This will require a formal tummy tuck revision.  Diligent abdominal binder use afterwards will also be very important.

All the best,

Dr Remus Repta

Remus Repta, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 87 reviews

Recurrent Seromas After Bariatric Plastic Surgery Can Be Related to Nutritional Issues

+1

Thank you for your question.  Recurrent seromas after abdominoplasty in a patient who has undergone bariatric surgery has a number of potential causes.  As you are aware, protein aborption can be an issue for bariatric patients and supplementation is important.  Some patients find it very difficulty to keep up with the protein requirements.  The stress of surgery also increases protein breakdown potentially further setting you behind.  Low protein levels can contribute to fluid accumulation by decreasing oncotic pressure...the body's way of keeping fluid within the blood and lymph system.  You may consider asking your doctor to check your protein levels...there are several different tests.  If low, supplementation will help in the healing process and decreasing the chance of fluid accumulating outside the lymph system.  If this fluid is accumulating in the groin region, a lymphocele or leaking of lymphatic fluid is also a consideration.  If drainage and recurrent aspiration has not worked, I would consider performing sclerois of the seroma site with an antibiotic called doxycycline  I would recommend discussing these issues with your surgeon further.  Best of luck.

Robert F. Centeno, MD, FACS
Fairfax Plastic Surgeon
5.0 out of 5 stars 28 reviews

Persistent Seromas

+1

I can understand your frustration as you've obviously been through a lot.  At this point I would recommend a second surgery to remove the seroma cavity, place progressive internal sutures to close the space between your abdominal muscles and the abdominal wall and possibly even the placement of "sealing" agents at the conclusion of the procedure.  While no one wants to go through another operation, it's your best chance for a speedy and pain free recovery.  Best of luck...

Eric Sadeh, MD
Manhattan Plastic Surgeon
5.0 out of 5 stars 22 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.