My seroma is not going away, help! Will alcohol injection help?

Question

I had a tummy tuck w/Lipo on July 22nd and developed a seroma on Aug. 14. Drained on Aug. 15. 150cc. 10cc-3rd time, 30cc-4th time after 4 days. 10cc-5th. 6th time he injected an iodine solution to help it heal on Aug 26. Told to return Aug 31. He did not drain but wants to inject it with an alcohol solution tomorrow. I am losing confidence. I thought it needed to be drained every other day. I feel like waiting 5 days was a step backwards. Should I get a 2nd opinion or have the injection?

Richard H. Tholen, MD, FACS · Answer

Every plastic surgeon has a regimen for treating seroma (unfortunately, some include ignoring) after tummy tuck, and yours seems to be doing just fine in terms of diminishing amounts. I personally prefer more rather than less frequent aspirations, then proceed to sclerotherapy with doxycycline, and have had to resort to more surgery only a couple of times in nearly 30 years of private practice.One of those surgical cases occurred after a radiologist convinced a dissillusioned-with-aspiration patient to undergo absolute alcohol injection. She developed a "rind" of dead tissue (that's what absolute alcohol does) that required surgical excision. So I'm not a fan of tissue-destroying agents. If the amounts remain small, ongoing healing will seal this up over time. Sounds as if both you and your surgeon might be trying too hard. Twice a week aspirations (unless amounts are large) are probably sufficient and yet not overkill. Best wishes! Dr. Tholen

Vishnu Rumalla, MD · Answer

Thanks for your inquiry.  You seem to have a very involved surgeon and the strategy seems to be working.  Please keep up your close follow up.  Good Luck.

Joseph L. Grzeskiewicz, MD, FACS · Answer

I'm sorry to hear that you are struggling with a seroma.  I think most surgeons who do a significant number of tummy tucks will tell you that they have been down this road with patients, and it's no fun.  In my experience, most seromas are self-limited, and with diligent management, they usually resolve on their own.  There is the rare instance, for me in which this doesn't happen, and we have to proceed to more aggressive measures, like injecting things, called "sclerosants," or in the most extreme cases, surgery to remove a "bursa" lining the seroma cavity.  Let me give you a bit of background first, so this all makes sense.  When we do tummy tucks, we are lifting the skin and fat off of the muscle layer, and this creates a space.  Even when we pull the skin back down and sew the wound edges at the bottom back together, that space is still under the skin.  Sometimes we use stitches on the undersurface of the fat, called "quilting sutures," or "progressive tension sutures," to close off that space more effectively.  We also use drains sometimes to keep the space empty from fluid and allow the surfaces of that space to heal back together.  This is basically how a seroma happens.  If none of the above measures were taken, or if the drain came out too early, or even if it was left in long enough but the space simply opened back up, the body will fill that space with fluid.  This is a seroma.  If we don't keep that fluid out of there, it will just stay, and the tissues on the surface of the cavity will begin to form a lining called a "bursa."  This is not necessarily a dangerous thing acutely, but it can cause some problems down the line possibly, and we simply don't want the extra fullness.  So we manage these things to make them go away.  The typical first line of attack is to wear compression garments and do serial aspirations, or drainage of the fluid with a needle in the office.  The strategy here is to simply keep the tissues pressed together without fluid holding them apart so that they will heal and close off the space.  Typically I have my patients come in two to three times a week for drainage, and we do this until the seroma resolves.  Honestly, I have had a few patients that this went on for over a month.  However, I would say that in the vast majority of cases - like 98 or 99% for me - this is all that has been necessary, and the seromas resolved with only this.  In those few cases in which it wasn't, we would next resort to placement of some type of continuous indwelling drain tube, like a Seroma-Cath, or maybe even a small surgical drain.  This then allows for the continuous removal of the fluid, and the space normally heals at that point.  If this doesn't do the trick, it usually means that the lining of the space has formed, and it won't heal without either damaging the lining layer or surgically removing it altogether.  In most instances we resort first to attempts at "damaging" the lining layer so that it will then heal together by scarring closed, and this is usually done by injecting chemicals known as "sclerosants" to injure tissues, or cause "sclerosis," or scarring.  So things like alcohol or certain irritating antibiotics might be examples of this.  Your surgeon will know for sure what the best option is among all of those, as he is the one who understands the time course and what was done in your initial surgery, as well as the extent of the current fluid collection.  However, a second opinion in person by another experienced board certified plastic surgeon, who can personally examine you and see exactly what is going on with your tissues, is never a bad idea, as often times that can not only confirm your own surgeon's plan, but it can give you reassurance that things are OK.  Best of luck to you, and most of all try not to get too discouraged . . . . I know it's easy to do in these situations.

My seroma is not going away, help! Will alcohol injection help?

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My seroma is not going away, help! Will alcohol injection help?

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