What's going on with the skin around my scar? (Photo)

Question

Hello. I had brachioplasty 4 weeks ago today. I have a stubborn seroma that I've had drained 4 times now. I can't keep missing work to go get it drained. Should I just lay low and give it time? Also, the skin around the seroma is puckered and unsightly. Will this correct itself as the seroma goes down, or will this require removal? Third, I have 2 open wounds on the upper part of my arm. I'm having a tough time getting them to scab. Any suggestions on how to help it heal more quickly? Thanks in advance!

J. Timothy Katzen, MD, FACS · Answer

Hello Jennasunshine in Lexington,
Thank you for your question about the issues with the skin around your arm lift (brachioplasty) scar, and for providing your history and pictures. It's not uncommon to experience a seroma following brachioplasty. A seroma is an accumulation of serous fluid, which is a natural fluid your body produces to help wound edges adhere. However, sometimes the body produces an excessive amount of this fluid, leading to seroma formation.
The optimal treatment for a seroma is needle drainage aspiration, which should ideally be performed every other day. This method often resolves the issue. If needle aspirations don't suffice, injecting a chemical to sclerose, or scar down the seroma, can be an effective alternative. Another approach involves inserting a drain to help reduce the seroma, but this can be inconvenient as it requires being attached to a drain for days or weeks until the seroma resolves. Surgical removal of the seroma capsule may be necessary if these treatments don't work, although this is rarely required.
It's important not to "just lay low and give it time" as seromas do not typically resolve without intervention. Regarding the puckered and unsightly skin around the seroma, this should improve once the seroma is resolved, as the puckering is due to the underlying distended skin. I don't anticipate that the skin around the seroma will require removal.
For the two upper wounds on your arm, I suggest applying an ointment such as Venelex or mupirocin to aid in their healing.
Thank you again for your question about the skin issues following your arm lift and the underlying seroma. I wish you the best in resolving this complication.
Sincerely,
Dr. Katzen

Juris Bunkis, MD, FACS - Account Suspended · Answer

Four weeks after your procedure, especially if you are having problems, you should be in touch with your surgeon almost daily, not surfing the web for solutions!   Please call and go see your doctor!    My advice regarding the open areas (which are very common following major skin resections) is to do a wet-to-dry dressing using Dakin's solution and the openings will heal just fine.   I would not let them "scab".   A scab is an extra layer of dead tissue and takes way longer to fall off/heal.    With regards to the seroma, your surgeon should insert a drain and keep it there until you stop draining and heal - otherwise you may develop a wall of scar tissue around the seroma that will have to be surgically resected in the future.

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