How Long Should It Take a Seroma of Only 10ml to Resolve & What (If Any) Treatment Would You Recommend?

Question

I am 5.5 weeks postop from a rectus plication (without tummy tuck) for a severe diastisis recti. My drain was removed & a large hematoma was found at 7 days p.o. Soon, I developed a large seroma in my lower abdomen. Another drain was placed when serial aspiration failed & was removed after 2.5 wks when drainage was 15ml per day for 3 days. A small seroma developed 24 hours after removal. 10ml was aspirated from it 4 days later. When should it resolve & what can be done to speed up the process?

Robert Kearney, MD, FACS · Answer

Not much can be done to speed up the process. If you only had ten cc aspirated you are probably close to the end of the process.  Pressure garments might help but most of it will resolve over time.

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.  I have never seen an infection from sterile aspiration of fluid.  If seromas continue despite multiple aspirations over an extended period of time, then you need to start thinking about re-openning the incision and excising the entire capsule, both from and back walls, to treat the seroma.  Drains need to be placed, internal sutures placed, possibly using a tissue glue or irritant to encourage the tissues to grow together.Best wishes,Pablo Prichard, MD

Lisa Cassileth, MD, FACS · Answer

With an aspirate volume as low as 10cc, your doctor will be unlikely to continue to aspirate, assuming that all of it was removed. If it continues to build up, your doctor may aspirate it again. Try putting a pressure garment on, like spanx or a binder. Expect the area to be overly full and bulging even if there is no fluid, as the seroma produces a rind which thickens the area for at least 3-6 months. Some seromas can become chronic, although it's pretty unlikely, especially if you keep some pressure on it so the space collapses. Finally, this condition is very common with rectus diastasis repiar w/out the tuck, because the muscle and fascia get smaller where the skin does not, creating loose skin that is more likely to form a seroma.

Jourdan Gottlieb, MD · Answer

It more aspirations are needed, ask your surgeon about sclerosis--injection of a caustic substance (betadine, tetracycline, alcohol) to irritate the edges of the cavity and encourage them to stick together and stop secreting fluid. 

	If your surgeon is not familiar with this, an interventional radiologist probably will be.

	All the best.

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How Long Should It Take a Seroma of Only 10ml to Resolve & What (If Any) Treatment Would You Recommend?

Answers (4)

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Answer: What Treatment Would You Recommend-small recurring seroma

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