Seroma, doctor refuses to drain?

Question

I had a lower body lift on 11/7/16, after 120 weight loss. I now have what I would guess is a larger seroma in from pubis area (see pictures). My PS says seromas do not need draining and the really are more of a nusance. I am so scared I am going to ruin the work we did.... what can I do?

J. Timothy Katzen, MD, FACS · Answer

Hi Hopeful04, Congratulations on having undergone a 360 circumferential lower body lift. From the pictures of your scars, you look great. What is concerning is the collection in your pubic region or your mons. It appears that the mons could be full of fluid and be a seroma. Another thing I've seen in the hundreds of body lifts I have performed, is a collection of skin and fat in this area. This I believe is due to stretching of the supra-pubic or mons skin. First, I would suggest you get an ultrasound. If your plastic surgeon won't order it, perhaps your primary care doctor can order the ultrasound.  If this area is fluid filled, I would get the fluid drained. In my experience, the best way to drain this type of fluid is to make a small incision and place a Penrose drain. This is a piece of rubber which allows fluid to escape passively.  The Penrose drain is not a negative pressure drain. Negative pressure drains suck fluid from the wound and can stimulate a seroma to continue for weeks. A Penrose does not do this. Thank you for your questions regarding the presence of a seroma after a 360 circumferential lower body lift. If you have any other questions regarding postoperative treatment after a 360 circumferential lower body lift, please contact my office. Good luck.  Sincerely, Dr. Katzen.

Dallas Buchanan, MD · Answer

Thank you for your pictures and questions. Without an exam, it can be hard to tell what is really going on. If you are three months postop and still have a seroma, this is likely not going to resolve without intervention in my opinion. Best of luck!

Manuel Ventura Gonzalez, MD · Answer

Thank you for your question, Hopeful04. Every surgeon has his recommendations after surgery, however my recommendation would be to perform a soft tissue sonography in the affected area to determine if it is actually a seroma with accumulating liquid that needs to be drained, you could also continue to place your belt around the area to create pressure and help reduce that abdominal swelling.
Also, you need to remember that after performing a body lift surgery there are patients who have a faster recovery than others.

Curtis Wong, MD · Answer

Seromas, if proven, should be drained repeatedly until they resolve.  But you could have tissue there that simulates the look of a seroma.  So if you want to prove this, you can get an ultrasound.  I prefer to do the clinical thing and attempt an aspiration with a liposuction cannula (as needles may not be long enough) and this is repeated weekly until its gone.  Seromas don't just go away... they lead to the formation of cavities that impede your tissues from adhering to each other.  So do some homework about seromas and take that information in with you when you see your surgeon for reasons why you would not attempt an aspiration.

Seroma, doctor refuses to drain?

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