How Often Should I Have my Seroma Aspirated? Every Few Days or on my Weekly Scheduled Appointment?

Question

I had tummy tuck with lipo to flanks and inner thigh areas and breast augmentation. Seroma was aspirated on 2/18/13. I am noticing similar wave motion developing again. My next appointment is on Monday 2/25/13.

Richard H. Tholen, MD, FACS · Answer

For a succinct answer, read Dr. DiFrancesco's excellent reply. I know that small seromas can be allowed to resorb on their own, but an expanding seroma (fluid wave implies larger volume) in an early post-op patient may actually disrupt healing and increase the risk of developing a pseudobursa requiring drain replacement, sclerodesis, and/or re-operation to remove the cavity lining so that this can heal down.

	With this in mind, I try to see my patients every few days if they are local and note fluid recurring, so that decompression of the seroma cavity allows the periphery to heal down and gradually reduce the capacity for more fluid to accumulate. As the aspiration volumes decrease, we know we're doing the proper thing and healing continues until no more fluid remains.

	For me, re-operation (including drain replacement or sclerodesis) is a MUCH bigger pain and cost (for me AND my patient) than repeat aspiration. But since your surgeon is the one that will have to deal with the outcome of your joint decisions about aspiration frequency, this is a discussion best had with your surgeon. Best wishes! Dr. Tholen

Kenneth Hughes, MD · Answer

I prefer to aspirate the fluid collection if they cause contour deformity right away.  Your plastic surgeon should be informed and make the decision.  Kenneth Hughes, MD Los Angeles, CA

Shim Ching, MD · Answer

Aspirating your seroma may increase the risk of infection.  If the seroma comes back quickly, it may be better to wait and see if the fluid resolves spontaneously.  Wearing compression garments is believed to help.  Please trust your surgeon and follow his advice on how to treat your problem.

	 

	Best of luck and thank you for your question.

Pablo Prichard, MD · Answer

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.  If seromas continue despite multiple aspirations over an extended period of time, then you need to start thinking about re-openning the incision and excising the entire capsule, both from and back walls, to treat the seroma.  Drains need to be placed, internal sutures placed, possibly using a tissue glue or irritant to encourage the tissues to grow together.Best wishes,Pablo Prichard, MD

Lisa M. DiFrancesco, MD · Answer

Thank you for your question. The frequency for seroma aspiration really depends on the amount of fluid aspirated, how quickly the fluid returns and the level of discomfort for the patient. Your concerns are valid and you should discuss this with your surgeon.

Jourdan Gottlieb, MD · Answer

This question should be directed to your surgeon, who knows you, knows what was done, and has followed your recovery. Call,and let your surgeon decide, based on some give and take over the phone whether you should be seen earlier than on Monday.

	 

	All the best.

How Often Should I Have my Seroma Aspirated? Every Few Days or on my Weekly Scheduled Appointment?

Answers (6)

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