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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

Doctor Answers (11)

Treatment of Seroma After Tummy Tuck

+2

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.


Santa Ana Plastic Surgeon
4.5 out of 5 stars 8 reviews

Seroma and 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.
Best wishes,
Pablo Prichard, MD

Pablo Prichard, MD
Phoenix Plastic Surgeon
5.0 out of 5 stars 27 reviews

Re: Seroma after tummy tuck (abdominoplasty)

+1

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.

William F. DeLuca Jr, MD
Albany Plastic Surgeon
5.0 out of 5 stars 110 reviews

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Seroma managenent: controversial

+1

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.

Otto Joseph Placik, MD
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Seroma after abdominoplasty

+1

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. 

Hayley Brown, MD
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Seroma Should Be Drained

+1

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.

Christopher V. Pelletiere, MD
Barrington Plastic Surgeon
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Seromas need to be drained after a tummy tuck if they are large enough

+1

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.

Richard P. Rand, MD, FACS
Seattle Plastic Surgeon
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Seroma after Tummy Tuck Procedure

+1

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.

Good luck.

Farbod Esmailian, MD
Orange County Plastic Surgeon
5.0 out of 5 stars 35 reviews

Management of Seroma after Tummy Tuck Surgery

+1

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.

Good Luck.

Dr. Peter Aldea

Peter A. Aldea, MD
Memphis Plastic Surgeon
5.0 out of 5 stars 60 reviews

Seroma after tummy tuck

+1

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.

Steven Schuster, MD
Boca Raton Plastic Surgeon
4.5 out of 5 stars 3 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.