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Tummy Tuck Seroma? Fluid Won't Drain.

3 weeks post FTT. Drains removed one week ago and swelling worsened. Yesterday, I noticed when I push on a large lump in my pubic area, I can see the fluid displace and come up in my lower left abdomen. I can see the "waterbed effect" when I lie down and push on parts of my lower abd. and the hard spot in my pubic area disappears and is flat again. PS tried aspiration (placed syringe in lower left abdomen) but nothing would come out. Could it be something else? What can I do?

Doctor Answers (9)

Tummy tuck seroma; aspiration attempt failed. What to do now?

+2

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!


Minneapolis Plastic Surgeon
5.0 out of 5 stars 126 reviews

Seroma aspiration after tummy tuck is common

+2

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

S. Sean Younai, MD, FACS
Beverly Hills Plastic Surgeon
4.5 out of 5 stars 26 reviews

Seroma after tummy tuck

+2

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

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

Brent Moelleken, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 96 reviews

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Tummy Tuck Seroma? Fluid Won't Drain.

+2

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!

Amy T. Bandy, DO, FACS
Newport Beach Plastic Surgeon
5.0 out of 5 stars 86 reviews

Sometimes a longer needle is needed to aspirate the seroma

+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 28 reviews

Seroma (fluid) after tummy tuck

+1

Historically, seromas have been the most common post operative complication of abdominoplastys. They generally respond to serial aspirations which, if the accumulation is substantial as it appears in your case, is not overly difficult to perform succesfully. It generally takes several aspirations and will require diminished activities along with compression. Other options involve placement of a seroma catheter - which is in essence replacing your drain to allow a continuous removal of the fluid.

It is imperative that the seroma is treated, since a chronic seroma cavity can significantly alter your post operative result with firmness and fullness above the surgical incision (which would require re-operation to remove the cavity). Certainly if your plastic surgeon cannot find the cavity, a radiologist can place the catheter with ultra sonic guidance. Many plastic surgeons have altered their technique over the past several years to leave more deep tissue on the abdominal fascia and not skeletonize it as was the technique in the past. Leaving that tissue allows for better re-absorption of fluid and, in my practice, has made what was once a common post-operative occurrence, a thing of the past.

Regardless, first things first - contact your surgeon and have that fluid removed asap.

William F. DeLuca Jr, MD
Albany Plastic Surgeon
5.0 out of 5 stars 112 reviews

Seroma after Tummy Tuck / Abdominoplasty

+1

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.

David Shafer, MD
New York Plastic Surgeon
5.0 out of 5 stars 57 reviews

Seroma after Tummy Tuck

+1

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!

Gerald Minniti, MD, FACS
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 29 reviews

Seroma in abdomen 1 week after drain removal

+1

What you are describing is typical for a seroma of the abdomen. There clearly is a significant amount of fluid present that should be able to be aspirated. If allowed to continue untreated, not only will the deformity become larger and more symptomatic, but this could develop into a chronic problem with a persistent enclosed and lined seroma cavity. This would then require surgery to treat.

I recommend that you re-contact your plastic surgeon and have him/her make another attempt at aspiration of this seroma. You may require several aspirations and possibly even re-insertion of a drain tube.

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