Persistent Seroma 14 months after tummy tuck and muscle repair. What can I do? (Photo)

Thank you for your question regarding what to do with a persistent seroma many months after a tummy tuck. Thank you for your history. Let's review the definition of a seroma and a hematoma. A seroma is a collection of serous fluid. Serous fluid is your body's natural superglue that helps stitch edges together. This is usually clear yellow fluid. A hematoma is a collection of blood. Initially, the blood is usually bright red; as the oxygen leaves the blood, it becomes dark or purple. Your description of dark red material aspiration indicates that this is a hematoma at the time of aspiration. Sometimes, seromas turn into hematomas, and sometimes hematomas can turn into seromas. I agree with your plastic surgeon's course of action: he drained it until nothing could be drained, and steroids were also injected. At this point, there are two options. I would suggest conservative operations. Another option would be, if you genuinely want the mass to be removed, to make an incision over the mass and remove the scar tissue surrounding this resolved hematoma or seroma. I hope this helps answer your question about persistent seroma many months after a tummy tuck.
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At this point, there is likely a bursa or sac around the seroma. Repeated aspirations will not resolve the fluid. You could try drain placement with or without scarring agents to try to get the sac to collapse and seal. More likely, you need surgery to remove the sac around the seroma with drain placement, so everything can seal back down.

Dear Exuberant621881,
I understand your concern. However, without a proper assessment, it would be difficult to determine what went wrong. It is best that you visit your plastic surgeon for further assessment or ask for a second opinion. Only after a thorough examination, you can get proper recommendations and advice.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

I’ve answered this question many times. You need to have a penrose drain ( not any other type) placed in the pocket to establish drainage to the outside. Then the space will close up on its own. The drain will require a small scar and need to stay in for about one week

If it continues to refill, a small drain can be placed by radiology and left in place while you wear compression to hopefully get it to close and heal.

hi exuberant!
sorry to hear about your complication
after this much time without resolution I would recommend excison of the seroma capsule, but this would require lifting up the whole abdominal flap similar to your initial tummy tuck without the muscle tightening and has an extremely high success rate
another thing we could try is to place a drain through your belly button into the cavity which would be a much smaller procedure but this may be less effective
regards
Dr Sejal Patel

I'm sorry to hear of the persistent seroma issues you are experiencing. Typically if multiple aspirations of a seroma along with compression are not able to resolve it, a drain is placed. If a drain is not successful in eradicating it then surgical intervention is sometimes necessary.

Seromas need to be drained on a regular basis as soon as they are found until there is no fluid accumulation. This may mean coming into the doctors office every single day and having a drained. as soon as fluid builds up the tissue surfaces cannot be in contact because of the fluid and a capsule will form making an a chronic seroma.
These can only be treated successfully by drainage by doing it consecutively on a close interval like daily visits or through the placement of a drain. once a scar tissue capsule has formed it’s no longer treatable by drainage alone.Steroid injections is not standard of care for a chronic seroma.
Sclerosing agents have been tried but don’t work.
If your surgeon didn’t want to drain the fluid on a regular basis then they should’ve sent you to an interventional radiologist who could’ve placed a drain.
At this point it’s most likely too late and the placement of a drain will not be sufficient. There is an window of opportunity to treat these nonsurgically by draining them but it requires keeping the fluid from accumulating continuously.
The more time that goes by the less successful draining of the fluid becomes.
If you let the fluid accumulate the drainage becomes pointless.
Chronic seromas can really only be treated by direct surgical excision.
On the lower abdomen they can be removed by going through the tummy tuck scar. it’s possible that going through the old incision could be done to surgically excise the seroma without creating a new scar.
It’s a big dissection to go from your old incision because your seroma is up on your chest wall.
I think you’ll find all non-surgical options futile and the fluid will continue to return.
Dark red fluid would indicate that you had a hematoma and the blood clot slowly dissolved.Plastic surgeons should be trained and educated in the management of a seroma.
I can’t speak on behalf of your provider but that is my understanding of them and how I have managed them in the past.
Continue following up with your provider or seek a second opinion through an in person consultation with other local board-certified plastic surgeons if desired.
Best,
Mats Hagstrom MD

Hi and welcome to our forum!
I'm sorry to hear of your difficulties following your abdominoplasty.
From your photos, I note the presence of a mass in the right upper quadrant of the abdomen. It has already proven to be a seroma, requiring serial aspirations.
A seroma is a collection of tissue fluid accumulating at the operative site. It is caused by injury to the soft tissues. When blood vessels and lymphatics get damaged through the normal course of the operative procedure, the body mounts an inflammatory response, resulting in the production of clear fluid. Normally, the body absorbs this fluid, but, if excessive, it will accumulate and create a seroma.
Small seromas will naturally resorb, but larger seromas require drainage. Serial needle aspirations may be required. If repeated aspirations fail to control the seroma, a drain is placed and is usually left in place until the drainage subsides. If the seroma persists for more than several months, sclerosing solutions (we employ doxycycline) can be introduced through the drain to create scar which will retard fluid accumulation. In unusual instances, surgical excision of the tissue making up the walls of the seroma is required. Closing the resulting defect with a quilt like technique appears to be of benefit.

As exploration of the seroma requires reopening the entire abdominoplasty incision (or a direct approach which will leave a scar in the right upper quadrant of the abdomen), I can appreciate his / her hesitation.
Options at this time (14 months post surgery) include surgical correction or continued watchful waiting.
Continue follow-up with your plastic surgeon.
Best wishes...