Recurring seroma after tummy tuck and catastrophic dehiscence

Question

Tummy tuck Jan. ‘24. 4 wks later, 7.5” of incision burst open. Since then, large seroma has reduced fr 40-60ccs/day to 7ccs/day, then restarted @ 40-60ccs/day. Now on 3rd instance, very bloody, increasing vol. 30 aspirations so far. U/S and CT scan show nothing. Doctor says other MDs haven’t seen & nothing relevant in med lit. Now saying IR-inserted drain, then sclerosing, then surgery. Cases like mine? Advice re treatment? Long-term harm possib? MD wrong in lack of urgency and treatment?

Stefan Mark Szczerba, MD · Answer

In these scenarios, the critical component of treatment is drain placement.  You have that now and if it's time to start sclerosing the pocket of fluid that's ok.  If that is not solving the problem, re-excision of the seroma pocket may be needed.  I'm not sure if there was any deviation from the standard of care but at least you know the overall treatment plan for now.  Best Wishes!!

J. Timothy Katzen, MD, FACS · Answer

Thank you for your question regarding the recurring seroma and dehiscence following your tummy tuck. Recurring seromas and wound dehiscence (where the incision reopens) are challenging but not uncommon complications. Here are some insights and considerations based on cases like yours:

Recurring Seromas: Persistent seromas can sometimes develop a thick, fibrous wall around the fluid collection, which makes them harder to treat. Repeated aspirations, while helpful short-term, may contribute to tissue irritation and prolonged seroma formation.

Possible Causes of Recurrence: Factors like the surgical technique, your activity level, and any previous history of seromas can contribute to persistence. If scans are inconclusive, it’s possible that residual fluid pockets or scar tissue are still present.

Treatment Options:

IR-Inserted Drain: An interventional radiology (IR)-inserted drain can allow for continuous drainage, which may reduce the need for frequent aspirations and allow the cavity to collapse over time.
Sclerotherapy: Introducing a sclerosing agent (like doxycycline) through the drain may help scar down the seroma pocket and prevent further fluid buildup. This is a more aggressive approach but can be very effective.
Surgical Revision: In persistent cases, surgery to remove the seroma capsule or address any unhealed tissue may be necessary.
Potential Long-Term Risks: Untreated or recurrent seromas can lead to infection, excessive scar formation, or even chronic swelling in the area. If left unresolved, it may also impair the quality of your final result and increase discomfort.

Lack of Urgency in Treatment: While your situation is complex, it’s reasonable to expect that your surgeon would pursue more aggressive treatment options, especially since this is now the third recurrence. If you feel your concerns are not being adequately addressed, consider seeking a second opinion from a plastic surgeon with experience in managing complex seromas and wound complications.

Thank you for sharing your journey, and I hope these insights are helpful as you discuss your treatment options with your medical team.

Sincerely,
Dr. Katzen

Camille Cash, MD · Answer

I'm sorry to hear of the issues you have been experiencing from surgery.  It sounds like you are working closely with your surgeon to address the seroma.  They can be problematic and can sometimes require surgical intervention.  If you are unsure of your surgeon's plan there is no harm in getting a second opinion or seeing a wound care specialist for an evaluation.

Connie Hiers, MD, FACS · Answer

I am so very sorry that you are experiencing this. Yes, this does happen to others and surgeons who have practiced for a while do see this problem. Sometimes a cavity of scar tissue forms where the seroma is and must be removed to prevent the seroma reoccurring. I am surprised that the ultrasound and CT scan do not show this. Dye could be added and rescanned and the cavity would then show.

Mats Hagstrom, MD (license on probation) · Answer

Seromas basically Come into versions, depending on how long they’ve been present.
Ideally, they should be treated aggressively as soon as identified to minimize the chance of the space becoming encapsulated.
Once the fluid collection develops a capsule, it becomes a chronic seroma. If a capsule has been developed, then they are no longer treatable by aspiration and sclerosing typically will not work.
At that point, it needs open surgical excision of the capsule with placement of a drain. 
At this point, most likely you going to need the capsule exercise with surgery.
I wouldn’t spend too much effort attempting to treat a seroma that’s been present this long in a non-surgical manner.
Surgeons, the web sufficient amounts of experience with this should know what to do.
The key is to treat these aggressively as soon as they identified to minimize the chance of encapsulation. That is the only window of opportunity to treat them without surgery.
Encapsulation begins within a few weeks.Good luck,
Mats Hagstrom MD

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Recurring seroma after tummy tuck and catastrophic dehiscence

Answers (5)

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