Could I have a Pseudobursa? (Photos)

Question

So I'm 3 months post op tummy tuck, I'm almost certain that I have pseudobursa I was drained for seroma at least 5 times I still have a bulge above my belly button that won't go down completely it's tender to touch I wear 2 binders with a board . I know that surgery has to be done to remove the pseudobursa, but should this surgery be done asap? Also is it safe to exercise? Because it seems to get bigger when I exercise. My PS said initially that it was swelling, but only 5cc's were drained 5 weeks ago

Nelson Castillo, MD · Answer

Thank you for your question and series of photographs and I am sorry that your results have not been what you anticipated.  It is difficult without an in-person examination to determine what may be taking place.  Most commonly this is residual swelling from surgery which will spontaneously resolve but it would be important to voice your concerns to your surgeon to ensure that other issues are not taking place - discrete fluid collection, muscle laxity, or residual adipose tissue. Should this prove to be a pseudobursa - which can be seen on ultrasound or CT scan - I would allow your results to mature for at least six months before proceeding with its removal.  Hope this helps.

Giovanna Ghafoori, MD · Answer

Hi, Kamarijr.  It is certainly possible to develop a pseudobursa from a persistent post-operative seroma.  It is possible to have developed fluid since your last aspiration five weeks ago.
Generally, unless there is a lot of inflammation, thickness form scar tissue, or a lot of fatty tissue, the seroma would still be palpable.  However, a CT scan, US, or exploratory aspiration would provide better clarity.
Some other causes of upper abdominal bulging after a tummy tuck include persistent swelling, internal abdominal fat, failed muscle repair/recurrent diastasis, or excessively weak muscles.  I would encourage you to follow-up with your surgeon for re-evaluation -- he/she would be in the best situation to diagnose and manage this problem.
Best of luck to you!

Daniel Krochmal, MD, FACS · Answer

Thank you for your question.  It's possible that you have one, but that can really only be diagnosed on physical exam.  I would continue to follow along with your plastic surgeon and follow their recommendations.  Surgery for the pseudobursa doesn't need to be done urgently, and if anything, it's better the longer you wait so that the surrounding scar tissue relaxes and the tissue becomes healthier.Best,Dr. Dan KrochmalMAE Plastic SurgeryNorthbrook, IL

Steven Wallach, MD · Answer

A pseudobursa can be seen on CT scan.    I would give it 4-6 months before operating on it to allow for the soft tissues to soften a bit.

Marc J. Salzman, MD, FACS (retired) · Answer

Thank you for your question and photographs. In my experience, most if not all contour regularities after tummy tuck are related to fluid. When the,fluid collection has been around for a while, your body may try to wall it off with scar tissue which we call a pseudo-bursa. In our office, we use ultrasound to easily diagnose this thick-walled, fluid-filled sac. Should that be present, it's been my experience that only a surgical excision will alleviate the situation. Your plastic surgeon can  advise you on what treatment parameters they may want to try. Hope that's helpful.

Could I have a Pseudobursa? (Photos)

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Could I have a Pseudobursa? (Photos)

Answers (5)

Answer: Pseudobursa

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Answer: Could I have a pseudobursae?

Answer: Could I have a pseudobursae?

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