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Should my Plastic Surgeon Use Sodium Morrhuate After Draining my Seroma from a Tummy Tuck?

I had a tummy tuck 4 1/2 weeks ago and have had my drains removed for about a week and a half. I developed a seroma about 3 days after the removal of the drains. It has getting bigger since then. I talked to my plastic surgeon yesterday and he wants to aspirate it tomorrow and then inject sodium morrhuate to help the skin to adhere. Is this safe? Is this a good idea? Is this a normal solution to a seroma? Thank you!!

Doctor Answers (10)

Seromas Following Body Surgery

+3

Seromas after abdominoplasties are a nusance at the least and if not taken care of can lead to the need for further surgery.  I have done many body procedures; lots of them after massive weight loss.  Lifting the tissues off the abdominal muscles so they can be pulled tight leaves large raw surface areas that must stick back together.  Think of it as a big rug burn.  It weeps the same clear yellow fluid it would on your knee or elbow.  So drains are needed to remove that collecting fluid so the tissues can adhere together again.  

Often I use dissolvable tacking sutures to hold the flap of skin down to the muscle.  Compression after surgery is important .  You also want to keep activity limited to short walks around the house.  You should not be cleaning, doing laundry and so on.  No twisting movements!  This causes shearing between the skin flap and the muscles.  I wait until each drain is less than 30 cc per 24 hours.  This can take up to two weeks.  After that I start worrying about infection. These measures do not always work.  If a seroma collects after the drains are removed it must be aspirated.  This usually has to be done several times. 

Some of us are juicier than other and I have resorted to a short course of steroids or diurectics.  Occasionally I have had to put the drains back in.  I have never found injections of antibiotics to help.  I have not tried sodium morrhuate, but colleagues have told me it doesn't work any better than tetracycline.   If  the fluid is not removed a thin layer of scar tissue forms around it the same as it does around a breast implant. We often refer to this as a bursa. The inside surface is slick and once it forms the tissues will not stick back together.  The skin will look loose and sag a little.  The bursa will need to be excised surgically (and yes, you will need drains again).  


San Diego Plastic Surgeon
4.5 out of 5 stars 11 reviews

Seroms after 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. If a seroma keeps recurring after an extended period of time of aspiration, It may be advisable to re-open the area and remove the entire capsule, both front and back walls of the capsule, otherwise it will come back. Drains need to be used, possible tissue glue, internal sutures, use of an irritant to encourage the tissues to grow together.
Best wishes,
Pablo Prichard, MD

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

Seroma pocket and recurrence

+1

Your plastic surgeon is in the best position to help decide what the problem is and how to correct it. If he has experience using a sclerosant to close down the pocket it is okay.   If the fluid keeps collecting then a drainage tube may have to be re-inserted.  If you are draining less then 25 cc each time then it is likely that this will resolve on its own.  Once it is totally gone it will not come back.

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon
5.0 out of 5 stars 10 reviews

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+1

Use of sclerosant agents in a chronic seroma is controversial. Sodium Morrhuate is an option but is generally condidered unnecessary.

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Seroma after Tummy Tuck

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Should my Plastic Surgeon Use Sodium Morrhuate After Draining my Seroma from a Tummy Tuck?
I had a tummy tuck 4 1/2 weeks ago and have had my drains removed for about a week and a half. I developed a seroma about 3 days after the removal of the drains. It has getting bigger since then. I talked to my plastic surgeon yesterday and he wants to aspirate it tomorrow and then inject sodium morrhuate to help the skin to adhere. Is this safe? Is this a good idea? Is this a normal solution to a seroma? Thank you!!

I do not have significant issues with seromas after tummy tuck.  However, on those rare occasion where the patient develops fluid after removal of the drains, simple aspiration has worked along with good compression.  I have not had to use sclerosing agents to make the skin adhere and I would not use it just after one aspiration.  Most surgeons use these agents when that have attempted everything, aspiration, drain placement, compression. etc.

Good luck.

Farbod Esmailian, MD
Orange County Plastic Surgeon
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Sclerosants for seromas

+1

Most post-operative seromas can be effectively treated with aspiration, although it may be required more than once. I have used sclerosing agents successfully for seromas, but typically reserve that option for situations where aspiration alone does not work. It is also important to use compression garments and limit strenuous activity after drainage procedures to allow the tissues to adhere.

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Correction of recurrent Seroma (fluid Collection) after Tummy Tuck

+1
I completely agree with Dr. Rand's comments. I have a significant experience with Tummy Tuck (Abdominoplasty) surgery and have never had to use sclerosing (severe inflammation provoking) agents to correct a prolonged draining seroma. To prevent such a situation the drains should be kept longer - until the drainage is below a certain threshold. If a seroma appears, it must not be allowed to accumulate but needs to be aspirated (using a syringe) several times a week. In my experience that would correct 99.9% of all such cases. You need to know that using Doxycycline (an antibiotic) or Sodium Morrhuate (a severe irritant used get rid of spider veins) are both off label uses not endorsed by the FDA. Dr. Peter Aldea

Peter A. Aldea, MD
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Seroma draining

+1

I have found that just draining the seroma once or twice and if need be putting a drain back in will more than take care of it.  I personally have not used that inconjunction with seroma drainage

Steven Schuster, MD
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Tummy tuck seromas

+1

I have personally never needed to do that but you should ask your doctor what their experience is with sodium moruate.  I used to do that or use tetracycline in malignant chest fluid collections way back when I was in general surgery but never since.  For me, a series of aspirations usually solves the problem and rarely the insertion of a Penrose drain is necessary.  The greatest problems we see with seromas are in the massive weight loss patient, not the routine tummy tuck patient.

Richard P. Rand, MD, FACS
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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.