Is It OK to Just Wait for a Large Seroma to Disappear on Its Own? (photo)

Question

I am 10 days post op. on day 1 I looked amazing and then the swelling set in. I had my drains taken out at 2 days P.O. I have a very large text book waterbed like seroma on the top and bottom of my abdomen. I am in Europe and I guess they just do things differently here. I have been looked at twice and told it is fine. I am uncomfortable with the amount of swelling and afraid of complications of the seroma. My (general) surgeon does not want to drain it because of the risk of infection.

Vincent N. Zubowicz, MD · Answer

I can't tell from the photograph whether you indeed have a seroma. However if one is present it should be drained and should be repeated until the serum is no longer accumulating.

Peter D. Geldner, MD · Answer

A seroma can develop into a chronic scar which will nor spontaneously reduce itself. These chronic seromas require surgical intervention. Seromas can become abscesses, true, but it is extremely unlikely of good aseptic technique is used. I long standing seroma can become infected if left alone. I cannot in good faith comment on the decisions of your doctor, however, my protocols are different.

Darryl J. Blinski, MD · Answer

It is just the opposite in that you need re insertion of drainage system in order to prevent an infection///

Malcolm D. Paul, MD · Answer

This must be drained. At this point in time, it may be necessary to reopen your abdomen and place basting sutures to close the space and prevent further fluid accumulation. If drainage persists several days after placing a drain, injecting solutions to cause closure of the pocket or reoperation may be necessary. Large seromas do not go away without treatment and, once the pocket is matured, only additional measures such as injections of various chemicals or open exploration will solve the problem.

Richard Bloom, MBBS (Hons), FRACS · Answer

Hi there Amelia,

	I agree with the other responses. If the seroma is large then it should be drained, the question is, whether or not it is large, and that is difficult to tell from the photos. An examination should be able to determine how much of your swelling is infact seroma.

	Draining the seroma is pretty safe and unlikely to cause an infection if done properly.

	I'm not sure how long you are in Europe for, but perhaps you could get whichever surgeon you are seeing there, to contact your plastic surgeon for reassurance. 

	Hope that helps,

	 

	Richard Bloom

	Plastic Surgeon

	Board Chairman Plastic Surgery

	Melbourne, Australia

Peter J. Simon, MD · Answer

I drain large postop seromas. Sometimes they recur and need multiple drainages. The goal is to allow the binder to compress the abdominal skin flap down to the fascia(muscle), so that the dead space is obliterated and results in a nicer aesthetic result. I tend to leave in drains for a week to decrease the incidence of seromas. Drainage and compression usually allows the fluid to become less and absorbed. Hope this helps.

Stephen Salerno, MBBS, FRACS · Answer

Hello and thanks for your question.

	It is true that small seromas can be left alone and will spontaneously resorbe with some time however larger seromas will usually require removall as they will take a long time to resorbe and can also feel uncomfortable.  Yes there is a small risk of infection when draining seromas however the risk of this is small.  Just do remember that even if it is drained it may recur adn take several episodes of draining before the seroma may completely settle down.

	Hope all goes well, regards

	Stephen Salerno

Sugene Kim, MD, FACS · Answer

Thank you for your photos. Although our bodies may reabsorb a small seroma, a large seroma needs to be drained. Without aspirating the seroma soon, your body may form a capsule around the seroma (like a bursa) and may give you a chronic problem. You should wear a compression garment and see your plastic surgeon soon. Good luck.

Richard P. Glunk, MD (retired) · Answer

There are many differing views on the treatment of seromas. Personally, I aspirate seromas using sterile technique in the office. I then use a compression garment 24/7 except for showers until the seroma is gone. Aspiration can cause complications but it is rare. Untreated seromas may resorb but large seromas may form a lining similar to a cyst if they persist for an extended period of time.

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