Found out It's a Hematoma Now What? (photo)

Question

i had tummy tuck surgery in november and developed a lump on my upper abdomen within a month post op i just had a ultra sound scan and was told it is a hematoma what do i do now? my doctor will eventually get back to me but i want to know my options before hand. i was told that liposuction can get me rid of this problem is this true? as i'm planning on getting lipo in the next few months.

Gregory T. Lynam, MD · Answer

At this point in time the hematoma is probably a thick liquid and may be removed in the doctors office with a large needle. A small amount of local anesthesia may be needed but this should be a quick 10 minute procedure. Some times there will be prolonged inflammation and massage or even re aspiration is needed. You should do fine. Good luck!

Daniel J. Pyo, MD · Answer

Lucy, this hematoma is fairly mature by now, and will have a fairly thick and established capsule.  You should see if the ultrasound was able to determine how thick the capsule is.  If it is a fairly thin capsule, then aspiration alone may do the trick.  If it is a thick capsule, then if may require removal through an incision.  Liposuction will not completely address the hematoma either.  I would definitely advise dealing with the hematoma prior to the liposuction procedure.

Pablo Prichard, MD · Answer

Dear Lucy,

	Thank you for your question.  A hematoma this far out will be encapsulated by now.  It may be solid or a liquid.  If a liquid, then may be able to be aspirated by a needle and syringe.  This should be attempted first as it has the least amount of morbidity for you.  If it is solid and does not come out, or if it recurs after coming out, then this is a pseudobursa and will need to be removed surgically.  Liposuction can help if you have thick enough tissue on top of the mass by removing fat from the area on top of the mass.  The capsule of a pseudobursa is to thick to be penetrated by the liposuction cannula and will just bounce off.  So with liposuction, you are not getting rid of the mass, just hiding it by blending it in with the surounding tissue.  The only way to remove a pseudobursa, however, is to open the incision again, elevate the abdominal tissue, and directly remove it and all of the walls of the pseudobursa to prevent recurrance.

	Best Wishes,

	Pablo Prichard, MD

R. Morgan Davoudi, MD · Answer

It is absolutely imperative that the hematoma is addressed.  The longer it remains, the more difficult it is to manage, not to mention the possibility of it forming into an abcess (a pocket of infection).  This can easily be done by the surgeon through aspiration with a needle, placing  a drain tube, a radiologist, or by direct exploration in the operating room.   Be sure you are wearing your abdominal binder.  Best wishes

Jourdan Gottlieb, MD · Answer

I would try to get some resolution before your liposuction surgery, because if whatever is tried fails. an open operation may be required.

	This looks big enough that your surgeon should be able to aspirate the fluid with a needle, or insert a drain.

	The issue with a well established hematoma is that the surrounding tissue forms a membrane, and the longer it is present the more difficult it is to eradicate, and occasionally requires open surgery. It would make sense do to this at the time of liposuction (presumably to other areas). 

	All the best.

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