Possible Fluid Build Up Since Drains Were Removed?

Question

I had a revision tummy tuck on 5/3/12. I my drains were draining less than 25cc on 5/14/12. I don't have any redness or swelling so far, but I noticed today that when I depress the middle of my lower abdomen, to the left of the area I press is having a "wave". The best way I can describe it is like when you press up and down on a water bed and it creates sort of a wave. There isn't any pain associated with it and I don't have any drainage or fever. Is this something that will absorb on its own?

S. Larry Schlesinger, MD, FACS · Answer

Thank you for your excellent description.  You, in fact, have a seroma.  That is a collection of fluid between the skin and muscle, and it has boundaries and you need to get rid of it sooner rather than later.  There are multiple reasons that could lead to this seroma, but the easy answer is that your lymphatics (those vessels that drain away excess fluid) at this point are overwhelmed by whatever fluid present, and therefore there is a fluid buildup in a pocket under the skin of your abdomen.  To allow the lymphatics to get strong enough to drain this fluid, you need to decrease the fluid and keep the fluid decreased for several days to a week.  The best method that I know of is called a Seromacath.  It is a clever little draining tube.  Your plastic surgeon can numb the skin, put it in, drain away the fluid for a couple of days until your pocket scars shut, then it can be removed easily.  Your skin is numbed, there is absolutely no pain involved, and this is a clever little trick that has been very useful in my practice. 

	Unfortunately, all plastic surgeons get seromas sometimes.  Please call your personal plastic surgeon and tell him or her what is going on.  I am sure he or she will do an excellent job of resolving this minor bump in your recovery road.

Richard J. Bruneteau, MD · Answer

Based on
your history you appear to have classic seroma formation.Seroma formation is a common problem
following tummy tuck surgery.In an
effort to minimize this complication, surgeons utilize drains in the
post-operative period.These drains are typically
left in place for 7 to 14 days following surgery.They are usually removed when drainage drops
below 25 cc per 24 hours.After the drains are removed, seroma
fluid can continue to develop for a limited period of time.In most cases, the body resorbs this fluid
before it can develop into a seroma.In
some cases, this fluid accumulates faster than the body’s capacity to resorb
it.When this occurs, seroma formation
can result.This occurs when patients
are physically active.Once a seroma forms, serial
percutaneous aspirations with a needle and syringe are necessary.If this continues percutaneous CT-guided
drain placement may be necessary.In
rare cases, placing a sclerosing agent into the seroma cavity may be necessary
to prevent seroma formation.Although most seromas don’t
represent a significant problem, they should be removed.Seroma removal helps decrease the potential
for infection and wound break down.It
also makes recovery a more comfortable experience.The vast majority of seromas have resolved in
six weeks, but occasionally they persist for longer periods of time.Clinically significant seromas should always
be drained.

Tom J. Pousti, MD · Answer

Thank you for the question.

	The “wave” sensation that you have described is a classic  physical examination finding associated with the presence of a fluid collection. Sometimes this fluid collection absorbs on its own;  usually however aspiration is necessary.  Often, several episodes of aspiration is necessary.

	Follow-up with your plastic surgeon for precise diagnosis/treatment.

	Best wishes.

Sugene Kim, MD, FACS · Answer

It seems like you have a seroma from your description.  When you see and feel the "wave," you need aspiration of the fluid.  You may need once or more aspiration of the fluid and need to wear the compression garment for several weeks so that you do not re-accumulate the fluid again.  You also want to limit your activity level.  It is not emergent problem; however, you should contact your plastic surgeon to address the situation soon. Best wishes.

Remus Repta, MD · Answer

Hello,

	It certainly sounds like you have a seroma which is a collection of healing fluid.  This fluid should be aspirate (drained) and the abdominal binder should be worn snug and consistently to prevent the fluid from re-collecting.  You may have to have your plastic surgeon evaluate and aspirate the seroma fluid several times at 2-3 day intervals before it subsides.  Seroma fluid that is left alone and does not get absorbed can lead to pseudobursa formation.

	All the best,

	Dr. Remus Repta

Possible Fluid Build Up Since Drains Were Removed?

Answers (10)

Answer: Seroma after revision tummy tuck

Answer: Seroma after revision tummy tuck

Answer: Seroma fluid should be drained

Answer: Seroma fluid should be drained

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Possible Fluid Build Up Since Drains Were Removed?

Answers (10)

Answer: Seroma after revision tummy tuck

Answer: Seroma after revision tummy tuck

Answer: Seroma fluid should be drained

Answer: Seroma fluid should be drained

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Recommended reading

Everything you need to know about Tummy Tuck Revision

Our mission is to create a world where every investment in modern beauty is Worth It.