Tummy Tuck Seroma? Fluid Won't Drain.

It’s not
unusual for patients to develop seromas following abdominoplasty.The problem may occur for a variety of
reasons in the post-operative period.In
some cases, the drains may have been removed prematurely, while in other cases,
patient activity levels are just too high.Regardless of the cause, clinically significant seromas should be
treated as soon as possible to avoid additional complications.Failure to address this problem can result in
the formation of chronic seromas, infection, drainage, wound break down and a
less than optimal result.When this situation arises,
treatment usually consists of serial aspirations and the use of compression garments.At this point the abdomen is still numb and
can be easily aspirated.This usually addresses
the problem, but occasionally more aggressive treatment is necessary.In cases where aspiration has been
unsuccessful, drainage with ultrasonic guidance may be appropriate.Under these circumstances it may be
appropriate to leave a drain in place. In other cases failed aspiration may indicate
that the seroma isn’t clinically significant. It’s safe to say that the vast
majority of seromas are successfully treated with conservative management.For this reason, it’s important to maintain
close contact with your plastic surgeon.

If your surgeon tried to drain your seroma with a syringe and it didn’t decrease in size, then you can either try again or you may require surgery to remove it.

What needs to happen immediately (so this seroma cavity does not become permanent) is another attempt at aspiration. After over two decades of doing tummy tucks, I have had my fair share of seromas (and even a few after drains have been removed), but I have only failed to successfully aspirate 1 or 2 patients with extremely small seromas, or extremely thick subcutaneous fatty layers. Seromas large enough to have a visible fluid wave are able to be aspirated in virtually all patients, though in patients who have a very thick fat layer that a "normal" length needle would not reach through, I use a longer IV needle, or even spinal needle.

Surgical placement of a new drain (under local anesthesia) is pretty easy if needed, though the cost of doing this in the hospital or outpatient surgical center may be prohibitive if your surgeon does not have his own surgical facility.

"Letting this go" and not draining the seroma may cause you to develop a pseudobursa that requires general anesthesia to surgically remove. To prevent the need for this, see your surgeon again, promptly!

Yes, it sounds like you have a persistent seroma or fluid collection under your skin.  In most cases, the fluid can be drained by your plastic surgeon in the office by numbing the skin and then draining the fluid with a needle.  However, sometimes it requires a radiologist to drain the fluid.  In this procedure, the radiologist uses an ultrasound to look through the skin and see where the fluid collection is located.  The radiologist can then place a drain directly into the fluid collection.  It sounds like this is what you need to have done.

 

Good Luck.

it is common to experience a seroma after a tummy tuck. often if your plastic surgeon can't aspriate from one area he can try aspirating from another area. also it is very important to keep your activity level to a minimum and wear a tight binder to keep pressure over this area.

best wishes,

sean younai, MD

Hello The Babycakes,

I am sorry you are having this very common but frustrating problem known as a seroma.  I understand that your PS tried to aspirate it but was unsuccessful, however that doesn't mean that there isn't fluid there.  It is important to remove the fluid, so please return to your doctor for a second attempt.  If unsuccessful, you will need an ultrasound to find the fluid and perhaps have it drained at that time.  I am sure that this problem will be fixed and you should go on to have a normal healing process after this seroma is treated.

Best of luck!

It is usually very, very straightforward to aspirate a seroma.

Reschedule an appointment with your board certified plastic surgeon and have the seroma aspirated.

Sometimes when you have a seroma, it can be difficult for the surgeon to get the needle exaclty into the correct spot to drain the fluid.  I would go see him/her again, and if the attempt is unsuccessful, perhaps an ultra-sound guided aspiration would be recommended- or replacement of the drain.  Good luck!

What you are describing is consistent with seroma.  IF it's significant then it should be aspirated on an almost daily basis as the volumes increase.  If it is a significant seroma then there is a device on the market called a seroma-cath.  It is similar to just putting a drain back in but it's much smaller than a typical drain as the fluid of a seroma is very thin- almost watery.  The catheter is similar to a long IV catheter with multiple hoiles and it is inserted simply with a needlestick.  Your doctor should know about this product.  I hope this helps.

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