What options do I have to treat a recurring seroma after excision surgery? 2 years post abdominoplasty. (photo)

I’ve answered this question so many times I’m surprised other plastic surgeons didn’t pick up on it. You need a certain type of drain called a penrose drain. It needs to be placed in the space through about a half inch incision in the old scar. It then needs to drain to the outside for one week. Yes it’s a little messy for a few days but works like a charm every time

Dear Theresapaul,
I understand your concern. However, without a proper assessment, it would be difficult to determine what went wrong. It is best that you visit your plastic surgeon for further assessment or ask for a second opinion. Only after a thorough examination, you can get proper recommendations and advice.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Some general information on dealing with a recurring seroma after abdominoplasty. Some options might include:
1. Aspiration: A surgeon can use a needle to drain the seroma fluid. This may need to be repeated periodically if the seroma occurs.2. Compression: Wearing compression garments may help reduce the accumulation of fluid and promote healing. 3. Steroid injections: In some cases, corticosteroid injections can help reduce inflammation and prevent seroma recurrence.4. Surgical Revision: In severe or persistent cases, your surgeon may recommend a revision surgery to remove the seroma sac or repair any underlying issues.5. Supportive Care: Following your surgeon’s post-operative care instructions, including avoiding strenuous activities, can help minimize the risk of seroma formation.
Always consult with your surgeon or a medical professional for a proper evaluation and guidance on the best treatment approach for your specific situation.

At this far out in time, the cavity of the seroma needs to be removed because it is now well formed. Otherwise, you will keep making fluid.

I'm sorry that you've had so many issues with the seroma. Having the capsule removed along with drain placement should have fixed the issue. At this point I encourage you to continue to closely follow your surgeon's instructions. It seems she/he is working with you to resolve the seroma once and for all.

The correct management of a seroma is to have it drained on a daily basis immediately upon detection until no fluid is accumulated.
As long as there is fluid in the space the surfaces cannot be in contact and the tissues will not adhere to each other and the capsule begins to form.
There can be as a little time as possible between sessions of draining the seroma. It literally means coming in every day if possible.
A far better choice is to have the patient sent to interventional radiology where they can place a drain through the skin. This is something that’s difficult for surgeons to do but interventional radiologist have the tools to do it.
Once a capsule is formed no treatment will work other than complete excision of the capsule with closure of the seroma over a drain leaving the drain in long enough that there is no output for a long period of time.
If the entire capsule is not removed there is a risk of the procedure failing.
Anything short of these measures will fail.
Treatment needs to be aggressive continuous and there can be no half measures if you want success.
Injection of steroids or sclerosing agents are never useful.
Our plastic surgeons should know how to treat a seroma. Unfortunately some are not willing to put in the effort required to do it successfully on a consistent basis.
If your seroma recurred after complete excision then either all of the capsule tissue was not removed, the drain was not left in long enough, the two tissue surfaces were not sutured together or a combination of the above.
Consider having a second opinion consultation or ask for a referral to interventional radiology.
Depending on if your surgeon was meticulous when it came to capsule removal the excision of the seroma could be salvaged by reinserting a drain.
The drain will probably have to stay in for a long time.
While challenging and frustrating managing a seroma is not rocket science.
Best,Mats Hagstrom MD

If you have a seroma for too long, the body develops a wall around it (called capsule) and creates a space where the fluid keeps accumulating. This seems to be what has happened to you. In such a case we have to open up the incision, remove the wall (capsule), place a drain and close the incision. It is a minor surgery and much less extensive than your original abdominoplasty but it has to be done under general anesthesia.