I have developed a >10cm seroma on the right side of abdomen following abdominoplasty, 2 wks post op. My surgeon did insert a drain which pulled out after 2 days and the fluid was draining from the insertion site. She was going to reinsert a drain but decided not to. By ultrasound still much fluid remains. She refuses to do a needle aspiration due to infection risks. I am very concerned about the adherence ability of the skin above the seroma. What do I do now, if anything. Thank you
Seroma Formation After Abdominoplasty
Doctor Answers (11)
Treatment of Seroma After Tummy Tuck
If the seroma is still present, I aspirate the seroma every week. As of yet, I have not had any infections, although the risk is there (very small risk).
Not doing any thing with the seroma, however, is not a good idea, as it will continue to accumulate more fluid.
Seroma and Tummy Tuck
Pablo Prichard, MD
Re: Seroma after tummy tuck (abdominoplasty)
Seroma formation previously was not an uncommon complication to an abdominoplasty. More recently by maintaining more of the tissue beneath scarpa’s fascia this has fortunately become less of a problem. Performed sterilely, needle aspiration is the appropriate management of significant seromas, and I have never encountered an infection related to the aspiration process. This may need to be done on a 1-2 time per week interval until resolution while maintaining compression and limiting activities. Untreated seromas can result in a seroma cavity which will cause distortion to the abdominal wall particularly in the area above the incision resulting in a ledge like appearance. This would need to be secondarily excised removing the scar tissue to allow the abdominal tissue to lie flat. The general rule of thumb is to keep drains in until less than 25cc’s of fluid has been evacuated in a 24 hour period. This amount can easily be re-absorbed by the body and at the time of removal you should take it easy for a 24 hour period.
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Seroma managenent: controversial
There is some controversy in the management of seromas. In my practice, I tend to aspirate these repeatedly 1-2 times a week until it resolves. To the best of my knowledge this has never resulted in infection of teh fluid collection. However, one of my colleagues who is a general surgeon, rarely drains these and states that most will resolve on their own with time.
Seroma after abdominoplasty
I typically aspirate moderately sized seromas with a needle inserted into the fluid collection. Then I recommend a compression binder and some limitations on activity. These need to be followed with frequent visits, as they commonly will recur and require repeated aspirations until resolution. I have never seen an infection with this approach, however it is a risk.
Seroma Should Be Drained
Generally speaking, if done under sterile technique, then there should be very little worry about infection from draining a seroma. A seroma of a small enough size will resolve on its own, but after a certain point, it will just sit there and prevent some skin retraction. I would have another discussion with you surgeon about draining in percutaneously. I hope this helps.
Seromas need to be drained after a tummy tuck if they are large enough
A seroma is a well known complication of tummy tuck surgery. Taking a drain out at only 2 days is a bit early in my opinion as it increases your risk. Once you have one, if it is large enough it is better to aspirate it than to leave it alone. Several repeated aspirations may be needed. I have personally never had a patient get infected from aspiration so I don't worry about that much.
Seroma after Tummy Tuck Procedure
Seroma formation is the most common complication after a tummy tuck. There are certain things that I do to reduce this risk, and I have been able to bring my rate down tremendously. However, when a seroma forms after drain removal, I usually treat it with needle aspiration and compression. I will do this as long as the response is good and the seroma is small.
For larger seromas and ones that dont resolve with needle aspiration, which is not very often, I would then place a seroma catheter (drain).
Hope that gives you some idea on how I like to treat this.
Management of Seroma after Tummy Tuck Surgery
Regarding : "Seroma Formation After Abdominoplasty
I have developed a >10cm seroma on the right side of abdomen following abdominoplasty, 2 wks post op. My surgeon did insert a drain which pulled out after 2 days and the fluid was draining from the insertion site. She was going to reinsert a drain but decided not to. By ultrasound still much fluid remains. She refuses to do a needle aspiration due to infection risks. I am very concerned about the adherence ability of the skin above the seroma. What do I do now, if anything. Thank you"
As my colleagues have stated, seroma (fluid collection) is a frequent complication of Tummy Tuck surgery. However, annoying such complications may be, it is important to treat them aggressively to prevent them from becoming a chronic seroma pocket (IE a bursa) or an abscess.
Oftentimes a seroma can be dealt with effectively with serial needle aspirations in the office. Using sterile technique, the skin is numbed and the fluid is drawn out. The patient is placed back in a mild compression garment and is seen in 48 hours or sooner to asses progress. By keeping the fluid cavity collapses, the walls can adhere to each other and the seroma will go away. There is NO higher infection rate in doing it this way and this option is much more patient friendly and cheaper to the patient than being sent to an unfamiliar Radiology department for placement of a ultrasound guided drain.
In the uncommon case where several office aspirations fail and there seems to be no diminution in the amount of fluid aspiration, THEN I would refer the patient for a ultrasound guided drain placement. This is very uncommon.
Your situation is difficult because your surgeon seems to prefer not to try and aspirate the seroma. In such a case, you should have the drain place as soon as possible and keep it as long as possible while using mild compression to assure resolution of the seroma.
Dr. Peter Aldea
Seroma after tummy tuck
Seromas or fluid collections after a tummy tuck are very common. In most cases they go away by themselves. In some cases I will refer a patient to radiology to do a needle guided aspiration and drain placement for several days to a week if needed. Speak to your surgeon as this may be a good option. Good luck.