Huge lump after BBL, why??? (photos)

I am 2 1/2 months post op have been drained 5x kept compressed and lump still there. What to do?? Do I need a revision ?

Doctor Answers 4

Lumps this large after 2 1/2 months post-op should be evaluated in depth

I'm assuming that when you use the term "BBL," or "Brazilian Butt Lift," you are referring to a fat transfer procedure only, and that you don't have buttock implants in place.  If you do have implants, this would be a whole different matter, and it could indicate a number of things related to the implants themselves, including fluid around the implants, displacement of the implants, or injury to the tissues surrounding the implants.  However, I will dedicate my answer more to the assumption that you have undergone a fat transfer procedure to enhance your buttocks.  At this point, 2 1/2 months after fat transfer, those fat cells that are going to survive most likely will be surviving, and those that are not going to make it will have died and not made it.  Thus, I don't think that something this noticeable and this localized and constant is something that will simply change appreciably with more time.  Some general swelling may still resolve, and contours soften, but in the end, I would tend to be more aggressive with something like this early and try to figure it out.  The fact that you have already been "drained 5x" is of concern to me.  That indicates that you may have formed what would commonly be called a "pseudobursa"  in your tissues.  This happens when we have a fluid collection in soft tissues that persists for enough time that the body can form a layer of "lining" tissue around the space.  The problem with this is that the lining tissue does not heal well to itself on its own, and it may continue to produce fluid indefinitely.  Thus, repeated attempts at decompressing, or draining, the fluid will be met with recurrent fluid collection, because the problem is the lining tissue, or pseudobursa, and not the fluid itself.  These things can happen if large enough amounts of grafted fat don't survive the procedure.  The cells die and release their fatty oils into the tissue space, and this can cause the fluid collection ultimately resulting in the pseudobursa.  While it may be possible to make a pseudobursa disappear non-surgically by injecting certain medications and using long term compression or drainage with an indwelling drain, in some instances if this is not successful, we have to  surgically remove the pseudobursa to allow the tissues to heal.  Before I proceeded to that drastic step, I would want to be certain what I was dealing with.  Therefore, as I said above, this should be evaluated more thoroughly, and the easiest, cheapest, and least invasive test that I can think to start with to do this would be an ultrasound.  This study will not only tell us if the lump is fluid filled or solid, but it will give us an idea of the depth and dimensions of the area too.  In the event that the lump is solid, this could be more of a contour defect created by overaggressive grafting in one area with loss of graft volume immediately adjacent to it, usually from compression, and this can give us a similar appearance.  In that event, perhaps some liposuction and/or another round of fat transfer to even things out would be all that is required.  However, based upon your history to date, my money is on the fluid collection hypothesis. If your surgeon has not mentioned getting an ultrasound, I think it would be appropriate at this point to maybe gently ask if that has been considered and whether it might not be a good time to do it.  Draining something 2 or 3 times with recurrence is not uncommon, but 5 times with no significant improvement makes me think that further attempts at the same things aren't going to deliver much different results, and a different course may be appropriate.  Second opinions are always of value too, as sometimes we all run up against a brick wall and need a little help from our colleagues to figure things out.  As they say:  "No man (or surgeon) is an island,"  although sometimes we all find ourselves in that position.  Best of luck.

Huge lump after BBL, why???

Assuming that you had a traditional BBL with fat transfer to the buttocks, this is likely a seroma (given the history of being drained 5x). Compression helps along with a diuretic (of course prescribed and monitored by your doctor). Getting it drained is also a must because it can become infected. If the cavity forms a capsule then this can be very difficult to get rid of.

Lump after BBL

Thank you for your question and photographs.It is important to consult with your surgeon about any questions or concerns you may have seeing as they are the one that knows your medical history, anatomy and surgery best. 2 ½ months is still early in your recovery period and things are still settling and swelling is still resolving. I would give yourself at least 6 months and reevalute your results. If at that point you are still unhappy, I would consider a revision BBL with your plastic surgeon or another board certified plastic surgeon to fill out the depression above the bulge on your left buttock. This should give you a more pleasing and symmetrical appearance. 
Best of luck in your recovery!

James Fernau, MD, FACS
Board Certified ENT
Board Certified Plastic Surgery
Member of ASPS, ASAPS, ISAPS, The Rhinoplasty Society, AAFPRS, OTO/HNS, ASLMS, International Federation for Adipose Therapeutics & Science

James Fernau, MD, FACS
Pittsburgh Plastic Surgeon
4.9 out of 5 stars 64 reviews

Brazilian Butt Lift/ Fat grafting/Liposuction/ High Definition Procedures/Butt Implants

I appreciate your question. Since there has been a change in your post op course, please contact your surgeon so he/she can examine you and recommend the most appropriate treatment plan at this time.The best way to assess and give true advice would be an in-person exam.
Please see a board-certified plastic surgeon that specializes in aesthetic and restorative plastic surgery. Best of luck! Dr. Schwartz Board Certified Plastic Surgeon Director-Beverly Hills Breast and Body Institute #RealSelf100Surgeon #RealSelfCORESurgeon

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