Fluid Build-Up After Tummy Tuck

Question

I had a tummy tuck Feb 07,2011 and i have had fluid build up since i got my drains taken out about a week and a half ago. My stomach is like a water bed and i am bigger now than before i got the TT. I went to the doctor out of concern and they told me it would go away on its own but from what i read it can take years or be uncomfortable to let the body do it alone. The fluid doesn't seem to be going down at all and i look pregnant. What should i do?

Naveen Setty, MD · Answer

Your description seems to indicate a seroma (fluid collection) has occurred after the drain removal. Drains are placed after surgery to help minimize fluid collection that naturally occurs when the abdomen has been contoured as it has in a tummy tuck. If a small amount of fluid collects after drain removal, your body will often absorb it without difficulty. However, if there is a significant amount of fluid, it does need to be drained to prevent long-term complications. The best treatment approach is drainage done with a needle in the office followed by compressive garments. If the fluid continues to re-accumulate, another drain may need to be placed. Good luck!

David A. Bottger, MD · Answer

Your condition is consistent with a seroma, which is a collection of fluid underneath the abdominal flap. This should be addressed as it can be more difficult to resolve if it is left untreated early. Usually it will respond to needle aspirations in the office in conjunction with a pressure garment. You may require a number of aspiration sessions to completely resolve it. At times seromas can persist and require more aggressive treatments such as drains, sclerosing agents, or even surgery, but this is more the exception

Sam Jejurikar, MD · Answer

Hi Ladyjay,

	Sounds as though you have a seroma, which is a common complication after tummy tuck. A seroma is a collection of watery fluid - the same fluid which your drains dealt with. A seroma can serve as a significant nuisance postoperatively, and can interfere with the re-draping of the abdominal skin. Seromas are usually treated by repeated aspirations of the fluid over several weeks after surgery; sometimes, they require placement of a drain many weeks after surgery.

	It's not likely the fluid will simply go away on its own. Sometime, however, normal postoperative swelling can cause lower abdominal fullness. If this is the case, it will improve on its own over time. If your surgeon has examined you, I would defer to his judgement and experience. If you haven't seen him, I'd make sure he has the opportunity to evaluate you soon!

	Hope this helps. Best of luck.

David Shafer, MD, FACS · Answer

If there is fluid like you describe (waterbed), then it needs to be drained.  We often do what we call a wave test.  If you can push on the skin in one area, and the rest of the skin moves in waves, then there is fluid beneath the skin.  Draining the fluid is a simple office procedure.  If the fluid persists, then you may need to have the drain left in again and removed a week or so later.

	 

	Good Luck.

William Bruno, MD · Answer

It sounds like you have a seroma, which is an accumulation of fluid in the abdomen which can occur after the drains are removed.  This can happen in about 5-10% of all tummy tucks. 

	The fluid can be removed in the office by aspirating (sucking out) with a small needle. Occasionally certain medications can be injected into the area to minimize the fluid accumulation.

	You should follow up with your plastic surgeon for treatment of this seroma so that the fluid does not become infected or compromise your final abdominal contour.

	Best wishes,

	Dr. Bruno

Amy T. Bandy, DO, FACS · Answer

From you description, you have a seroma. This needs to be drained. I typically do this with a needle and syringe and follow my patient every few days until it is completely resolved. If it is as significant as you state "like a water bed" it is unlikely that it will resolve on its own any time soon!

Edward J. Bednar, MD · Answer

It is likely that a seroma can Occur after drain removal
You need to get additional drains to keep your fluid build up in check for now

Michael M. Omidi, MD, FACS · Answer

A seroma is a collection of fluid that should be removed either by aspiration or by drain placement.  Larger amounts like your description usually fare better with an active drain.   Best of Luck.Remember that an in-person exam with a board-certified plastic surgeon would be the best way to assess your situation and guarantee an individualized medical advice. Best of luck!

Pablo Prichard, MD · Answer

Thank you for your post.  Seromas can be painful and cause a cosmetic deformity, as well as sometimes leak.  The whole point of drains is to keep a seroma from happening in the first place.  If a drainless procedure was performed, and you had a seroma, or you had drains that were pulled and you subsequently had a seroma, then you should be drained, otherwise a capsule builds around the fluid making it permanent.  If a capsule builds around the seroma (pseudo bursa or encapsulated seroma) then the only way to remove the seroma is to surgically open the areas and excise the capsule, and close over drains to prevent another seroma from happening.  If the seroma is encapsulated and is tight and painful, then it can be confused with just swelling or fat.  An ultrasound is useful in distinguishing these and identifying the extent of the seroma. If the seroma is not yet encapsulated, then it is usually loose and has a 'fluid wave' or water bed type feel.  Occasionally, a seroma can also become infected, especially if a permanent braided suture was used.  This will have a hot, red appearance, and will eventually open up.  Seromas can be aspirated instead of surgically removed and a tight compression garment placed, however this needs to be done often and until it is gone.Best wishes,Pablo Prichard, MD

Lawrence Tong, MD, FACS, FRCSC · Answer

Dear ladyjay,

	If you have a fluid collection (seroma) that makes your tummy feel like a 'water bed' and you 'look pregnant' it means that it is fairly large. The problem with allowing a larger seroma to go away on its own:

	
		It can take weeks or even months to resolve
	
		the longer the seroma exists, the harder it is to resolve on its own
	
		if the seroma does resolve on its own, the skin overlying the seroma will pucker and become 'sucked in'. This will be especially noticeable at the incision, where the tummy skin above the incision will have a significant step off
	
		as the seroma becomes larger, you will feel more and more uncomfortable


	It  has been more than one month since your surgery. If it does still  does not show signs of resolving,  you should follow up with your plastic surgeon again. Good luck.

	Best regards,

	Lawrence Tong MD FACS FRCSC

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