Skin not reattaching to fascia and not a seroma after tummy tuck with muscle repair. Is there anything that can be done? (photos

Dear melrosaIt is too early to assess the outcome. The area will have prolonged edema and will take its time to take final shape. You should only consider revision after 4-6 months from last surgery. be patient. It will pay off. Sometimes early intervention can lead to long term unfavorable scarring and complications.

If a pocket persists after repeated drainage of a chronic seroma, it is often because the space has become lined with organized collagenous tissue to form a capsule or bursa. The diagnosis can often be confirmed with an ultrasound study. If this were confirmed there are many approaches to the treatment. This could include injection of an irritant into the space, compression,  or placement of drains. The definitive treatment would be surgical excision of the lining. These are issues that should be discussed with your surgeon. 

If the bulge came back two weeks after it was drained the last time and it was flat then, it could be a seroma or you may have separation of the plication suture(s) in that area.  Hard to say without an exam.  It is more likely to be a recurrent seroma in which case the skin may not attach to the fascia.  This would be from the seroma forming a surrounding scar capsule.  If you are not comfortable with the assessment of your surgeon, a second opinion is reasonable at this point. 

Hello,If the skin is not attached to fascia, then what occupies the intervening space? Air? No. It can only be fluid or seroma, if in fact that is true.  Conversely, this just may be localized swelling, though unlikely. Perhaps your surgeon should send you for a diagnostic ultrasound to see if there is any fluid that can be aspirated. Of perhaps you need to get a second opinion.Best of luck!

Thank you for your question and images. You scars appear to be healing well but in the scheme of post operative recovery 11 weeks is still early. I would always advise to take your surgeons advice first but I do believe there is a possibility for improvement. You could also continue wearing your pressure garments to encourage reattachment of the skin the the underlying tissues. I would also check with them again in regards to a fluid collection. RegardsDr Guy Watts

After a hematoma in formation of a chronic seroma the capsule that develops as an inflammatory response to this complication can become thickened. It will get better with time but in selected patients excision might be necessary.

Well, nature abhors a vacuum so if there is no fluid under that skin then the muscle is separated.  This is not so rare after abdominoplasty unfortunately.  It sounds like you had a harrowing experience and probably neither you nor your surgeon are eager to re-operate right now.  Give this some time --6 months at least then revisit this with your surgeon

The hematoma and seroma will delay wound healing in that area. I think compression and massage and time will improve the bulge.

At this time, I would still give it more time prior to revision.  In my practice, I would have my patient have endermologie treatments to try to help smooth the tissue out. It is a deep lipomassage treatment and is offered at plastic surgeon's offices and some med spas. Since you have had issues in that area, it may take 6 months to settle down.  Best wishes.