Please HELP! Is this a seroma? 11 weeks post TT (photos)

Question

My dr said I look fine and there is no seroma. I had one drained at 6 weeks post op. I am now 11 weeks out and feel there is fluid and have a pot belly. What should I do to improve this tummy tuck. Liposuction was not preformed.

Jonathan Heistein, MD · Answer

Hi. I'm sorry you are having an issue after your TT.  A seroma can be present but it is difficult to tell by a picture.  Go to your plastic surgeon and he/she can drain it if it is present.  Don't delay!  Good luck!

Matthias Solomon, MD · Answer

Only fool proof way to rule out a seroma is to do an ultrasound. This is typically not done because in most cases, a seroma is obvious on clinical exam. Have your doctor evaluate you and if there is doubt get an ultrasound of the abdominal wall.

Jane M. Rowley, MD · Answer

You might be swollen, you may indeed have a small seroma.  It is hard to tell from a photo.  The easiest thing to do is find a numb spot (which is easy), stick a needle in and see if any fluid comes out.  Talk to your surgeon.  Regardless, it will resolve, but you will feel and look better if it is drained. Good luck, Jane.

Giovanna Ghafoori, MD · Answer

Hi, MommyLof3.  I am sorry to hear that you are having problems after your tummy tuck and that you are concerned regarding the results.
A seroma is very difficult to see on photographs and is usually diagnosed by physical exam.  Typically, a fluid wave will be palpable and/or visible when the seroma cavity is pressed.  I try to distinguish for my patients the normal "trampoline" bounce or jiggle of normal skin as the swelling goes down, as opposed to a "water bed" wave.  Sometimes a seroma cavity can partially heal, leaving some fluid in tunnels.  This can be much more difficult to diagnose.  Also a small residual seroma may be such a thin layer that the characteristic wave is not present. 
The "pot belly" you describe may be due to many things.  If a seroma was the source, it would likely be a large seroma and obvious.  Some women are very slow to resolve their swelling -- I have found thinner patients, in particular, to have this issue.  Some women bloat on the inside and are slow to resolve.  Constipation will also swell the abdomen. Patient's who carry are considerable amount of intra-abdominal fat will have a more persistently protuberant belly.  If the muscles were not plicated, the belly will also protrude and have a pot belly appearance.
I find a correctly-fitting compression garment, avoidance of prolonged sitting and compression on the groin/lymph node area, avoidance of salt and simple sugars, a nutritious diet and massage help.
I would encourage you to follow-up with your surgeon for another evaluation.  An ultrasound or a CT scan with contrast can rule out missed fluid.  
Best of luck!

Vasdev Rai, MD · Answer

Call your surgeon and go back for evaluation.  Photos are poor substitute for in person exam. If it indeed is a seroma it will need to be aspirated.

Stephanie Olivier, MD, FRCSC · Answer

Thanks for your questions. Its really hard to say from the pictures, but i will say no. If you feel that you have fluid moving in lower part of your belly it can be a seroma, just ask to have a ultrasound. It will confirm it or not. Best wishes
Dr Stéphanie Olivier MD, FRCSC

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