After 4 Weeks Discovered I Had a Seroma

600cc is a lot. 4 weeks after surgery is late to find this out. You should probably be returning to office even twice a week to get a handle on this. If it doesn't dramatically improve within 2 weeks I would put in a drain. If a seroma is not adequately treated the undersurface of the skin may never "stick" back down, in which case you may always have a bit of fluid, and therefore fullness which remains.

One of the more common complications after any body contouring operation is a seroma.  Seromas are fluid collections that develop because of the potential space that can arise secondary to undermining.  Most plastic surgeons treat seromas with serial aspiration (with a needle and a large syringe) in the office, often on a weekly basis.  For large seromas (more than a couple hundred cc's) a drain is sometimes inserted in the office or the operating room.  Some surgeons will also try to speed the process by injecting a sclerosing agent into the cavity.  As you can imagine, each plastic surgeon is different.  Most of the time there aren't any long term negative effects.

Hello. Thank you for presenting us your case . You have what we call a chronic seroma . You must have patience with this and have good communication with your PS . The number of punctures is not the most important issue. You have to be sure that your PS is draining the seroma every time you go to his office. Remember to use your compression garment to avoid more seromas. Good luck.

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

If you have a  bulge at 5 weeks after your surgery it is either, a seroma, a hematoma, residual fat or muscle bulge.  Your plastic surgeon is in the best position to help decide what the problem is and how to correct it.  If the fluid keeps collecting then a drainage tube may have to be re-inserted.

A seroma after a tummy tuck is a common complication. Because the abdominal skin is lifted off of the abdominal muscle wall, there is a space between them where fluid can collect. Shearing forces can disrupt the scarring process which reattaches these two layers and the result is typically a seroma or fluid collection. The fluid may need to be aspirated multiple times over several weeks before it goes away. Wearing a compression garment can help prevent or reduce reaccumulation of this fluid. The problem with a seroma is that if the fluid stays in place, your body will build a scar capsule around it and it will never completely go away. By aspirating it, you give the body a chance to seal off the space which ultimately prevents further reaccumulation. Sclerosing agents can be injected into the space to help this scar tissue form, but in certain cases it takes a revision operation to correct.

There are several ways to limit the possibility of a seroma including surgical "quilting" sutures during the operation, leaving the loose lymphatic tissue on top of the muscle wall intact, and strict use of postoperative garments. Still, despite all of these manuevers, seromas continue to be a concern.

You might request to have a drainage system placed operatively to alleviate the need of needle aspiration. Just a thought. 

Seromas are a frequent occurrence with tummy tucks and the majority of plastic surgeons use drains to reduce their incidence. However, 600cc is a massively large seroma that took a relatively long time to accumulate. Depending on several factors, this can be treated with repeated but frequent aspirations that should be performed 2 - 3 times per week - once a week is inadequate. If the amount of aspirations each time doesn't show a trend to significantly reduction then placement of a drain should be considered. This usually can be performed in the office.

Given the volume that you have experienced, it may be prudent to pursue this course of action. A seroma that persists for a prolonged period of time can become a chronic problem due to the fact that the body forms a sac that sometimes needs to be removed with surgery.

If you have a postop seroma, it may need to be drained on more than one occasion. The alternatives are to drain during office visits or to place a catheter. Each plastic surgeon has his or her own protocol as to how to handle drainage. You haven't indicated whether drains were initially placed during your operation. I always use the drains to reduce the risk of seroma. Obviously, the drainage is a nuisance but it should not affect the outcome of the abdominoplasty. Please be patient and comply with your plastic surgeon's instructions. Speedy recovery!

Hello,

A seroma is just a collection of healing fluid but if present for large periods of time it can form a pseudo-bursa which is essentially scar tissue that can result in fullness in the area.  I would have it drained 2-3 times per week and wear your abdominal binder religiously.  The other option is to have your plastic surgeon place a seroma catheter or drain.  You should be wearing your abdominal binder essentially around the clock except for showers.  Doing so will help the two sides of your tissue heal together and get rid of the seroma.  I have listed a web link regarding pseudo-bursa formation below if you need additional information.

All the best,

Dr Repta