I Have a Large Seroma 4 Years Post Tummy Tuck. I Have Moved out of State, How Can I Get This Fixed and Should I?

Question

I had a tummy tuck in 2008, and developed a seroma post-operatively. This was treated with serial draining and injecting sclerosing solution. I now have a large seroma (15cm x8cm x 4cm). The surgeon I saw since I have moved, tried to aspirate the fluid and was unable to remove much due to the viscosity of the fluid. I have moved from Virginia to Alaska, so seeing the original surgeon is not an option. What can I do? Kathy

Shahriar Mabourakh, MD, FACS · Answer

Based on your question the seroma has been present since 2008. Ultra sound or CT scan of the area would be appropriate to determine the problem. After such a long time most seromas tend to form a very thick capsule and become solid inside. You need a work up to see what the problem is before any recommendations can be made. Are there any local surgeons you can see, does not have to be a plastic surgeon possibly a general surgeon

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.Best wishes,Pablo Prichard, MD

Norman Bakshandeh Day, MD, FACS · Answer

Sounds like you have a bursa or a thick walled capsule that has formed around the fluid collection. This fluid will reaccumulate unless the bursa is excised surgically. Your recovery will be very quick after the procedure. I dont think there are any other good non surgical options that are available.

Remus Repta, MD · Answer

Hello,

	Thank you for the question.  I suspect you may have something called a pseudo bursa which is a pocket of scar tissue surrounding the seroma fluid.  The ideal correction would involve complete removal of the pseudo bursa as well as any offending agents such as permanent sutures etc.  Unfortunately this will require redoing a portion or all of the tummy tuck procedure.  It seems like a lot but its worth doing the right thing once as opposed to repeated attempts at smaller treatments such as aspirations, etc.

	All the best,

	Dr Remus Repta

Jourdan Gottlieb, MD · Answer

If this has been present for four years, it is probably lined by a thick walled membrane/scar, that will probably require surgical excision. Plastic surgeons will typically have more experience dealing with these than will other surgeons, but a general surgeon willing to tackle this problem would also be appropriate. 

	Although a seroma seems the likeliest diagnosis, it is not the only possibility, so getting in to see a physician for evaluation seems appropriate.

	Thank you for your question, best wishes.

Tom J. Pousti, MD · Answer

I'm sorry to hear about the complication you have experienced.   Based on your history, it is most likely that you are dealing with a chronic seroma. You will find that this type of fluid collection is surrounded by a relatively thick layer of scar tissue. Treatment will likely involve excision of the scar tissue (bursa)  through the existing tummy tuck incision line. Drains will be used.

	 I would suggest that you meet with well experienced board certified plastic surgeons in your area.  you will need to feel comfortable and develop a level of trust  prior to selecting a plastic surgeon who you feel will be able to achieve their goals.

	Best wishes.

Peter A. Aldea, MD · Answer

Hi Kathy,

	Sorry to hear of your condition.

	The treatment would be different if you had
	- a 4 year old fluid collection (seroma) dating back to your Tummy Tuck
	VS
	- a NEW seroma 4 years later (with a PAST history) of as recurrent seroma which was successfully treated with aspirations and sclerotherapy.

	If there's ANY doubt I think either a CT scan or MRI would be indicated to make sure it is not something else which may mask itself as a seroma (things like certain intraabdominal tumors, hernias etc). Once the identity is established and proven to be a seoma, you would probably require lifting the tummy skin, removal of the seroma pocket, now a bursa or worse, and closure over drains with progressive tension sutures to close the pocket.

	You may see a Plastic surgeon, preferably, or a General surgeon who would refer you to a Plastic surgeon IF needed.

	Good Luck.

	Peter A Aldea, MD
	Memphis, TN

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