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What Next, 3 Wks Post Tum Tuck with Newly Formed Fluid Collection?

Just to make it easier, i am a healthcare professional, had tum tuck 3 wks ago, with post op 2 drains, one removed at day 9 and one yesterday at day 14, in spite of it was draining 60-80 cc/day. The decision to take out made with my PS. Today there are swelling in the flanks and lower abd, it fits fluid collection, unlikely hematoma, as there are no bruises. now My DDx either seroma or inflamatory fluid, what shall I do, shall I aspirate it out, i can do that at home as my PS in different provin

Doctor Answers (8)

Management of Fluid collection after tummy tuck?

+2
Your dilemma results from earlier decisions. Relax, this is not life threatening, and should not compromise your result if appropriately managed. The seroma can be treated by serial aspiration, drain re-insertion, sclerosis, and/or re-operation. My advice, and likely the advice of your surgeon, don't drain this yourself.... Although, I must admit, if it were me, I'd probably be freezing daily with ethyl chloride and, with sterile technique, be draining with 18g needle into 60cc syringe with 3 way stopcock. Call your surgeon and develop a plan.


San Diego Plastic Surgeon
5.0 out of 5 stars 38 reviews

What Next, 3 Wks Post Tum Tuck with Newly Formed Fluid Collection?

+2

From my perspective, the drains were removed too early. Seek re insertion ASAP otherwise continual needle aspiration will be your course. As for self aspiration ONLY if the situation is desperate. 

Darryl J. Blinski, MD
Miami Plastic Surgeon
4.5 out of 5 stars 64 reviews

Seroma Formation three weeks after a Tummy Tuck

+2

It appears you have a seroma and that your drains may have been removed too soon. Even if you are a fellow surgeon, it would be inappropriate for you to aspirate your own seroma. I would suggest you ask your Plastic surgeon to help find a colleague closer to you to take over and do several serial aspirations of the seroma. In most cases, aspirating these every few says would resolve the seroma. If this does not work, ytou may consider ultrasound-guided placement of another drain. In very rare cases, seromas which do not resolve despite all measures may require a re-operation. With prompt care this is not apt to happen.

 

Peter A. Aldea, MD
Memphis Plastic Surgeon
5.0 out of 5 stars 62 reviews

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Tummy Tuck and Post Operative Fluid Collection

+2

At 15 days post tummy tuck and just having had the drains removed, I believe you are correct the what you are experiencing is the formation of a seroma.  Under no circumstances should you attempt to aspirate this seroma, yourself.  Even if you are a health care professional and practice sterile technique, you could have a complication - loss of blood pressure, faint, etc - and risk significant injury.  Contact your plastic surgeon, and if, he is not in your local region, ask him/her for a local, qualified physician who can evaluate and treat you.  Best of luck.

Vincent D. Lepore, MD
San Jose Plastic Surgeon
5.0 out of 5 stars 17 reviews

Tummy tuck and Seroma?

+2

Thank you for the question.

Your description fits perfectly with the presence of a seroma.  you should be evaluated by your plastic surgeon who will using sterile technique aspirate the seroma for you. Sometimes this aspiration ( which tends to be painless) needs to be repeated a few times.

Best wishes.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 759 reviews

Drains and Tummy Tucks

+1
Thank you for your post. Whenever there is a potential space in your body, your body tends to fill that space with serous fluid (the yellow type of fluid that also comes out of a 'weeping wound'. This is similar to when you get a blister: the layers of skin separate and fluid is deposited in to the space. In a tummy tuck, the space is in between the skin/fat layer and the muscle layer. Most surgeons will place a drain to remove this fluid while your body is secreting it until the fat layer grows back together with the muscle layer. At that point, no more fluid is secreted into the area, because there is no more space for fluid. The length of time that this takes varies from patient to patient. Some patients heal much faster, thus the layers seal together much faster. Also, the more twisting motion you have in your belly area, the slower the two layers grow back together because they are moving in relation to each other. The fluid coming through the drain can be initially dark red, and eventually clears to pink then yellow. This is because it takes just a little bit of blood to make the fluid dark red. Also, initially, there can be a large amount of fluid (few hundred cc's in the first day is not out of the range of normal) and this should slow down substantially over next few days. Once the fluid slows down to the amount that your surgeon is comfortable with (usually 25-50 cc in 24 hours) then they will be pulled. There is minimal discomfort in pulling the drain in most patients.
More recently, 'drain free' surgery has become more popular. Fat layer is sutured down to the muscle layer starting at the ribs and progressively down to the lower incision. This makes the space for the fluid to collect much smaller, and in many patients can have surgery without drains. However, I have seen multiple patients come from other surgeons because they developed a seroma despite the suturing of the tissue. This is not the surgeon's fault, but some patients just do not heal fast enough or put out too much fluid for the body to absorb.
If you get a fluid collection after no drains or after drains being pulled out, these should be aspirated regularly and compressed until do not recurr. 
Best wishes,
Pablo Prichard, MD

Pablo Prichard, MD
Phoenix Plastic Surgeon
5.0 out of 5 stars 28 reviews

Treatment of a seroma after a tummy tuck

+1

Your fluid collection is clearly a seroma and this was quite predictable with the amount of fluid your drain was putting out just prior to removal.  Your best choice at this time is to have another drain inserted which could be accomplished percutaneously under local anesthesia by a general surgeon or a radiologist with ultrasound guidance. Serial aspiration is an option but I would not recommend that you try it yourself.

James McMahan, MD
Columbus Plastic Surgeon
5.0 out of 5 stars 11 reviews

Seroma After Drain Removal From A Tummy Tuck

+1

The development of a seroma after a tummy tuck is not a rare problem, despite having had drains in up to two weeks after surgery. While you can make an argument now that the drains were removed too early, most patients have little tolerance for them beyond a few weeks. Regardless, that is an irrelevant issue now. You need to get the area aspirated to remove the fluid and this will have to be done probably a few times before the fluid collection ceases. Usually patients will need to be tapped once a week until it stops accumulating. While it would be best to have a doctor doing the aspiration, I have had a few nurses over the years who were comfortable doing their own aspirations because of the inconvenience of travel

Barry L. Eppley, MD, DMD
Indianapolis Plastic Surgeon
5.0 out of 5 stars 27 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.