I Had Abdominal Hernia Surgery, Now I Have a Large, Painful Seroma. Options?

I agree with the other docs who said that something sounds fishy. A seroma is a collection of fluid. It needs to be drained, either with needle aspirations, placement of a drain, or open drainage. A tummy tuck is completely unrelated. Your surgeon (I presume a board certified general surgeon) should deal with with complication without suggesting that you undergo an elective cosmetic procedure.  If your original surgeon is not willing - or capable - of dealing with this common complication, then you need to seek another doctor.

It’s unusual
for patients to develop seromas when they undergo abdominal hernia
repairs. Occasionally seromas may be
seen following this procedure when the soft tissue has been extensively
undermined for exposure.Under these circumstances, treatment
of the seroma is necessary before secondary procedures should be
considered.Treatment usually requires
serial percutaneous aspirations.In some
cases, CT guided drain placement is appropriate.If patients continue to have loose
skin following wound healing and seroma resolution an abdominoplasty is a
consideration.Abdominoplasty shouldn’t
be considered a treatment for seromas, but instead a treatment for loose skin.Under these circumstances, it’s
appropriate to consult a board certified general surgeon.This surgeon should be able to manage both
your hernia repair and your seroma.If
residual aesthetic deformities are present after complete wound healing,
abdominoplasty may still be an option.

Thank you for your question. It is not necessary to have a tummy tuck to resolve a seroma. If you indeed have a painful seroma as a result of your hernia repair, then you should return to see the surgeon who did the hernia repair to address the seroma through surgical or non-surgical drainage. I hope this helps.

Many plastic surgeons are fully trained general surgeons (I was certified by the American Board of Surgery in 1986) prior to their plastic surgical training and certification, so we can offer proper advice regarding your situation.

If you have fluid under your skin following hernia repair, this could be a seroma, or it could be an indication that your hernia repair has partially or completely broken down, allowing peritoneal fluid (the fluid around your intrabdominal organs) to collect under the skin through what may be a recurrent hernia opening in your abdominal wall.

Difficult hernias are sometimes referred for specialized reconstructive procedures performed by a plastic surgeons (fully-trained ABPS-certified plastic surgeons are experts in reconstructive surgery as well as cosmetic surgery), but this is not elective tummy tuck cosmetic surgery.

Your general surgeon may be trying to deflect responsibility for your present troubles, or may simply be advising referral to a specialist with more surgical tools to attack your problem. It could be that he was simply trying to describe a plastic surgical reconstructive approach in terms he hoped you would understand (since most lay people have heard about tummy tucks), but is really saying he needs help from a reconstructive plastic surgeon consultant in your care. Insurance should cover continued care of your hernia-related problems and additional surgery (by either kind of surgeon--General or Plastic).

Often small or asymptomatic hernias are repaired by a plastic surgeon during the course of an elective cosmetic tummy tuck, but this can and should be part of your original hernia care. Talk to your general surgeon; if he really wants you to see a plastic surgeon, it's not for a "cosmetic" tummy tuck; it's for hernia reconstruction by different means. Also, be careful about any surgeon sticking needles into this "fluid-filled" cavity--it could be bowel!

You should return to your original surgeon, who should take respondsibility for your post operative care and treat the seroma until it is resolved.  An abdominoplasty during this early post operative period is not indicated and could potentially lead to increased complications.