Will encapsulated seroma/bursa go away on its own? (Photos)

Question

It’s almost a year post surgery. Does encapsulated seroma need to be surgically removed? Or can they go away on their own? Doctor who performed tummy tuck/lipo said it takes 2 years to go away. He said if he surgically removed it, it will come back. He said it’s better to wait. Is that true?

Roger Tsai, MD · Answer

Great question!  Unfortunately, once a capsule is formed around the seroma, it needs to be removed, it will not go away on its own after 1 year.  You can keep having it drained, but the shell needs to be removed otherwise it will keep collecting.  Once the capsule is removed, you will still require a drain as yes a seroma can still happen again, but this time the drain may need to be in place longer to ensure that there is only minimal amount of fluid buildup.  Best of luck and hope this information helps!- Dr. Roger Tsai  @DrRogerTsaiBoard Certified Plastic Surgeon

Gerald Minniti, MD, FACS · Answer

Hello,
If a bursa has formed (documented chronic seroma via ultrasound), it will (likely) never go away. The treatment of choice for this is marsupialization (animals with pouches for their newborns) of the pocket, a surgical procedure that leaves the seroma pocket open to the air. In your case, an incision in your belly button will allow the surgeon to insert a rubber tube (Penrose drain) into the pocket, sewing in place to your skin. This allows fluids to constantly drain, and bacteria to colonize the pocket. This in turn creates inflammation that will allow the walls to stick together and heal, without a risk of a new seroma to form. The drain is usually remove in 10 to 14 days, and sometimes sooner.

Ronald J. Edelson, MD · Answer

A seroma after a tummy tuck is a situation plastic surgeons commonly see but they don’t all treat them the same.  I start by needle aspiration every four or five days.  If it persists after that I  put a special type of drain called a pentose into the seroma through the abdominal scar and let it drain to the outside on gauze.  I remove the penrose  in a week.  By that time the seroma will have closed down around the drain.  It always works, it’s somple and can be done doctors office while awake.  It’s amazing how many plastic surgeons dont use this technique.

Donovan Rosas, MD · Answer

Early seromas can be drained post operatively by aspiration or re-insertion of a drain. A longstanding or chronic seroma will likely have organized and developed a capsule. Aspiration is usually ineffective in these cases as the dead space persists and usually re-accumulates fluid. In these cases, an open excision of the seroma capsule and placement of a drain is necessary.With regards to your specific question, a seroma which has persisted for nearly a year (in my experience) will need to be drained. I will typically attempt serial aspiration followed by drain replacement. If unsuccessful, seroma capsule excision is indicated. While it is true, the seroma can recur post excision, in the setting of an organized capsule it often represents the best chance for resolution.
As always, discuss your concerns with a board certified plastic surgeon (ABPS).

Donovan Rosas MD
Board Certified by the American Board of Plastic Surgery
Member: American Society for Aesthetic Plastic Surgery, American Society of Plastic Surgeons
RealSelf Top 100
RealSelf Hall of Fame

Daniel Barrett, MD · Answer

Dear Ruby1959,
In case of seroma in early postoperative period, repeated aspirations might help but if the seroma is a few months old or older, then it has a capsule and it requires a surgery in order to remove it. It is best that you visit your plastic surgeon for further assessment. Only after thorough examination you can get proper recommendations and advice.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Susan Buenaventura, MD, FACS · Answer

you should have an ultrasound or repeated drainages to be sure this is a seton.  If so, going back to surgery is the right course.  The bursa needs to be removed , new drains put in and an binder.  You should be fine after that.   The good news is that the abdomen usually looks even better once you have this done.  Hope that is helpful!

Johnson C. Lee, MD · Answer

A year long seroma will most likely have formed a shell or capsule of scar tissue. This will make it difficult for the fluid to go away on its own. You may still attempt non-surgical interventions by having the fluid drained and sclerotherapy at the same time to encourage the capsule to seal down on itself. Otherwise, you may need a revision surgery to excise the capsule entirely. There is always a risk of forming another one, but with proper use of sealants or drains, it is not likely to happen. Hope this helps!
Johnson C. Lee, MD 
Board-Certified Plastic Surgeon

Olivier Deigni, MD · Answer

Hi and thank you for your question and your picture.
An encapsulated seroma usually requires surgical excision and does not go away on its own. Early seromas are typically treated with serial aspiration and compression and sometimes placement of a drain. However, once a capsule has formed around the fluid collection, the preferred treatment is remove of that fluid with surgical excision of the capsule.
I recommend that you discuss your concerns thoroughly with your doctor. You may also seek a second opinion with a plastic surgeon who specializes in aesthetic plastic surgery. They may be able to provide additional treatment to help resolve this issue.
Best regards!
Olivier A. Deigni, MD, MPH
Houston Plastic Surgeon

Arian Mowlavi, MD, FACS (license on probation) · Answer

What you have is not a seroma but poorly tightened muscle looseness, called diastasis. The upper abdominal muscles were not tightened looser than the lower muscles. Your tummy tuck will have to be redone to correct what we call the "Muffin deformity". Please make a consultation with a tummy tuck specialist.

Will encapsulated seroma/bursa go away on its own? (Photos)

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