Seroma presented 5 months post surgery?

Question

I had a panniculectomy on 08/17/2017. Around mid-November I developed a seroma. My doctor has been aspirating the seroma once a week and the serous fluid has ranged from 600ccs at the beginning to 400 ccs just yesterday (week 10). Seroma does not appear to be getting smaller. Fluid output has not decreased. Should my surgeon be looking into excising the seroma?

J. Timothy Katzen, MD, FACS · Answer

It is unusual for a seroma to persist five months after a panniculectomy. Typically, seromas resolve on their own or with aspiration, but in your case, the fluid output has remained consistently high, which suggests the seroma cavity may not be collapsing as expected.

At this stage, continued aspiration alone may not be enough. Many experienced, board-certified plastic surgeons would consider additional options, such as sclerotherapy (injecting a sclerosant to help the seroma walls stick together), placing a drain, or even surgically excising the seroma capsule if it has formed a persistent pocket that is preventing proper healing.

Given that you are still draining 400ccs per week after 10 weeks of aspiration, it would be reasonable to discuss more definitive treatment options with your surgeon. If excision is necessary, it can often be done as an outpatient procedure.

I hope this helps! Best of luck with your healing process.

Sincerely,
Dr. J. Timothy Katzen, MD, MBA, FACS, FICS

Babak Moeinolmolki, MD, FACS · Answer

Hello,
Thank you for your question. I’m sorry to hear about your experience. The good news is that seromas are treatable and there are more treatment options than drainage and surgical excision (removal). It is not uncommon for seromas to require more than one type of treatment method before resolving (going away). If your doctor has not tried non-surgical methods such as steroids and antibiotic injections, it may be useful to suggest them. Generally surgical excision of the seroma cavity (tisure surrounding the fluid) is used as a last resort. Further discussion with your surgeon may reveal plans for additional non-surgical interventions to try before resorting to surgical treatment.
Best wishes for your recovery,
Dr. Moein

Randy Wong, MD · Answer

Late seroma formation can be frustrating and persistent.  Excision of the capsule is almost as involved as going through the surgery again and carries risk of bleeding or other complications.  Discuss with your surgeon the use of a powdered antibiotic, like tetracycline or erythromycin, to create inflammatory adhesion of the seroma lining along with a closed system indwelling drain to keep the fluid from accumulating.  You may need to wear a compression binder and limit activity for a few days while the adhesion sets up.

Seroma presented 5 months post surgery?

Answers (3)

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