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Post Op Seroma 15 Days After Full Tummy Tuck, How Can I Avoid Further Seromas?

I had a full tummy tuck 15 days ago. My ps took out my drains on day 5. I went in today for my second checkup, and I had developed a seroma. (I didn't see the waterbed type of waves, that I read about) He drained out 4 tubes of bloody drainage. What can I do to avoid further seromas? I am very compliant with my garment. Does it mean that I will have another seroma on my next appt in 5 days, just because I had one today?

Doctor Answers (10)

Tummy Tuck - Post Op Seroma 15 Days After Full Tummy Tuck, How Can I Avoid Further Seromas?

+2

You can't necessarily avoid it, but you can manage it

It is, perhaps unfortunately, not unheard of to have fluid accumulation after a tummy tuck, including a modified or mini tummy tuck, and particularly in association with lipo.  The main thing is to recognize that fluid as early as possible, and then to treat it.  That means draining it, and that can be done with reinsertion of drains, sequential aspiration or both. 

My general feeling is that if it's a relatively small amount of fluid, and that amount drops with each aspiration, it is okay to perform repeated aspirations, once or twice a week, for several weeks.  But if the amount goes up, or stays the same, or more aspirations are required (all of this is assuming that there are no systemic signs such as fever, chills, sweats, etc.) then drains need to be reinserted.  While disappointing, this is really nothing more than an annoyance, and it can speed the recovery dramatically.

So I would say that you can have another aspiration in a few days, and then perhaps one more after that - and unless the pattern is one of clear improvement, reinsertion of the drains should be strongly considered.

I hope that this helps, and good luck,

Dr. E

 


New York Plastic Surgeon
5.0 out of 5 stars 148 reviews

Seromas need to be drained often to keep a capsule from forming

+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.
Best wishes,
Pablo Prichard, MD

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

Post Op Seroma 15 Days After Full Tummy Tuck, How Can I Avoid Further Seromas?

+1

I usually find that I drain about half the amount of fluid compared to the week before. Therefore you can expect to have weekly aspirations over a period determined by the size of the original collection.

This is a 'complication' that is well-known to plastic surgeons - don't despair.

It is important to follow up closely with your surgeon to get the volume as close as possible to zero.

I also suggest wearing a compression garment as you appear to be doing.

It would be a very rare case that would require insertion of a catheter.

Good luck!

Eric Pugash, MD
Vancouver Plastic Surgeon
5.0 out of 5 stars 47 reviews

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Post Op Seroma 15 Days After Full Tummy Tuck, How Can I Avoid Further Seromas?

+1

If after 3 visits of seroma drainage over a few weeks than re insertion of a drainage tube is the next step. Best of luck. 

Darryl J. Blinski, MD
Miami Plastic Surgeon
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Seroma after tummy tuck

+1

Seroma is a common post surgical problem, and it is difficult to determine in advance when the fluid will not re-accumulate.  Avoiding excessive torso motion may help speed healing.  As long as the volume withdrawn by serial drainage at similar intervals is diminishing, the seroma is slowly resolving, and usually doesn't detract from the final result.

Steve Laverson, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 38 reviews

Seroma following a tummy tuck

+1

It is likely that you will need to be aspirated again but how many times - is unpredictable. Most patients will require several aspirations; some may even require re-insertion of a drain but it doesn't sound too likely in your situation though there is limited information. Wearing a compressive binder and not being extremely active may help.

It sounds like you are in good hands...

Steven Turkeltaub, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 20 reviews

Seromas after tummy tuck

+1

Once you have a seroma it may take several "aspirations", drainage with a needle to get it resolved. It sounds like your surgeon is on top of it. Continue to see him weekly until it is gone. I would continue with your compression garment and try not to be too active.

Ronald Schuster, MD
Baltimore Plastic Surgeon
4.5 out of 5 stars 23 reviews

Seromas after a tummy tuck

+1

There is no way to predict if you will get more fluid accumulating in that area, but the general thinking is, even if a small amount of fluid comes back, it is best to aspirate it as often as possible in order to allow the tissues to stick together. That is when the seroma will stop coming back. The longer the fluid is in there, the greater the chance of the seroma developing a pseudobursa or sack like structure around it and then it will usually continue to re-accumulate fluid. 

Julio Garcia, MD
Las Vegas Plastic Surgeon
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Seroma after Tummy tuck

+1

Thank you for the question.

Unfortunately, there is no knowing exactly how many aspiration sessions will be necessary before the seroma  does not recur.  Most of the time however somewhere between 2 and 5 sessions are required.  It may be helpful to apply a “soft” pressure dressing over the area of fluid accumulation and to limit strenuous activity during this time.

Continue close follow-up with your plastic surgeon and do not despair;  results of your surgery should not be affected by the presence  of the seroma.

I hope this helps.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 703 reviews

Aspiration of seromas often needs repeating

+1

Seromas tend to occur in procedures where a large potential empty space is created such as tummy tucks.  The drains are used to reduce the risk of seroma formation but they can occur after the drains have been removed. Unfortunately, once a seroma has developed enough to require aspiration, it is frequently necessary to perform several aspirations over the ensuing weeks before it stops forming.  Fortunately, these aspirations are relatively painless and the skin is still numb from surgery.

The only things that you can do to help reduce the recurrence of a seroma is to wear your garment firmly and religiously and to keep your activity down until it stops forming.

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