I think I have an infected seroma. Antibiotics don't seem to be working, and my PS has become a ghost. What should I do? (Photo)

Hello and thank you for your question and photos.
Based on your images, it seems that you may have some fluid/seroma accumulation in the lower abdomen. The only way to truly determine if this is the case is through a physical exam. Other imaging modalities can also be employed to include ultrasound and rarely CT scan of the abdomen. 
At this point my suggestion is that you visit a fully trained plastic surgeon in your community (of which there are many in Miami, FL) for a second opinion. That is, of course, if your original plastic surgeon is unwilling to see you in consultation.
Hope this helps answer the question. All the best!
Alex Zuriarrain, MD, Plastic Surgery

I am sorry to hear that you are having these difficulties and more sorry to hear that your surgeon is AWOL. That is not normal or the standard that we as Board-Certified Plastic Surgeons strive. The most important thing is that you receive medical attention. Please return to the ER or reach out to another Plastic Surgeon in your area.

Thank you for your question and series of photographs and I am sorry to hear of your recovery difficulties, especially regarding your surgeon.  It is difficult without an in-person examination to determine what may be taking place.  Most commonly this is residual swelling from surgery which will spontaneously resolve but it would be important to voice your concerns to your surgeon to ensure that other issues are not taking place - discrete fluid collection, muscle laxity, or residual adipose tissue. If someone has diagnosed you with a seroma you need an aspiration procedure to remove the fluid in the hopes of your tissues sealing appropriately.  I would present to your surgeon's office to be seen sooner than later.

Seromas need to be aspirated or drained with a drain tube.  Large ones don't go away on their own very quickly.  If you have fever, purulent drainage, or cellulitis in the abdominal wall, it could well be infected - fortunately, your photos don't seem to show that.If you surgeon is unavailable, best to get a second opinion.  Sometimes, a small drain, called a SeromaCath, which can be placed with local anesthesia, is very helpful.

If you indeed have a seroma, then you should have it aspirated to be sure it resolves.  This may require a few aspirations.  I guess at this point you could go to another plastic surgeon, but it is highly unusual for your surgeon not to be on top of this.  

I'm sorry you are experiencing issues after your surgery.  It does appear that you have a seroma which should be drained.  I encourage you to try to contact your surgeon again as he is most familiar with the details of your surgery.  If you are unsuccessful I would try to contact another board certified plastic surgeon in your area for assistance.  

Hi. You certainly appear to have a seroma, it doesn't look infected.  Antibiotics won't fix the problem.  You need to have it drained - this is a simple procedure that we do in the rooms.  If you can't get your plastic surgeon to see you, then your GP should arrange for it to be drained by a radiologist or for you to see another plastic surgeon.  I'm sorry to hear that you haven't had the access to your surgeon that you should have.  Keep persevering to be treated appropriately.  All the best Kim

I'm sorry to hear about your post-operative infection and seemingly missing plastic surgeon--you should have ready access to your surgeon after surgery. If your surgeon is for some reason unavailable, having a partner in the practice cover for their patients is standard for board-certified plastic surgeons. Have you tried calling the office to see if someone is covering for him/her?  If not, and you are still having fevers I would try to see if another plastic surgeon out of the practice can see you and/or return to the hospital since a seroma needs to be drained (usually with needle aspiration) ESPECIALLY in the setting of an infection.  Make sure to see board-certified plastic surgeons for best recommendations. Good luck!!!!

Most seromas requires drainage - either by repeated aspiration or placement of a drain. If chronic, a lining forms that may necessitate a re-operation to remove the fluid and the lining and place new drains. If infected, it is even more important to adequately treat it in a timely fashion. If you have no fever/redness/excess tenderness I suggest you keep your appointment with your surgeon. Otherwise you should be another experienced board-certified plastic surgeon.....soon.

Based on your before and after photos, it does look like the swelling is more than would be expected 4 weeks after a mini"- tummy tuck. You may have a seroma, but this is difficult to diagnose without an examination. It does not, however, look infected as there is not redness or drainage coming from the incisions.  Hopefully, you can get in with your PS quickly and work on a solution to alleviate your concerns. If you ever feel abandoned it is important to nicely convey your concerns and if not getting anywhere, go to another PS in your area.