Seroma After Abdominoplasty over 1 Year Post Op?

Question

Is it possible to develop a seroma over a year after the surgery? I had some trouble with seromas early on but they were aspirated and went away. Could twisting motion cause a seroma to reoccur? I started doing some ab exercises that involve twisting. It's not a serious seroma, but there may be some fluid accumulating.

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

Joseph L. Grzeskiewicz, MD, FACS · Answer

While I agree with other posters on this thread that you should absolutely have an evaluation by your surgeon, I disagree that it is unlikely that you have another seroma.  In fact, I would bet money that is what you have!  Especially since you say that you had seromas following your original surgery.  First of all, don't worry intensely; seromas are not themselves dangerous and pose no imminent threat to your health.  They just won't get better on their own.  What probably happened in your case is that the fluid in the seroma diminished to the point that you couldn't detect it, and maybe the bursa, or the lining of the seroma cavity "stuck" together enough that it didn't come back.  However, with the stress of your new exercise regimen the potential space opened back up, and it filled with some fluid all over again.  In such cases I think one usually needs to have the lining of the seroma removed surgically so that it is gone for once and for all.  I also use "quilting sutures" to prevent recurrence when I do this, and I keep a drain in for a long time until I'm satisfied that the tissues have healed.  How do I know this can happen?  Because I've seen it with my own eyes in my own practice and those of colleagues.  In fact, I currently have a patient on whom I did latissimus dorsi flaps for breast reconstruction several years ago.  She also had problems with postop seromas in her donor sites on her back, a common occurrence, and eventually they "went away" with serial aspiration.  Then about 2 weeks ago she came in with a golf ball sized swelling in the site of her old seroma on her back after her massage therapist did very vigorous massage trying to "break up scar tissue."  I've aspirated her twice now with drainage of old, dark  bloody fluid, and each time the fluid returns after a few days.  The massage opened up a poorly healed seroma cavity, and now she has a recurrent seroma after a few years.  She's on my schedule for surgical removal.  It's not a complicated thing, but I believe it's the only way to really address her problem for once and for all.  Best of luck to you.

Jeffrey Zwiren, MD · Answer

Seromas are not uncommon in the early healing period with an abdominoplasty but I would not expect to see a new one develop after one year.  If you feel something unusual it is time to see your plastic surgeon and an ultrasound may be beneficial to determine if there is a fluid filled pocket.

Gregory Park, MD - Account Suspended · Answer

If your seromas resolved with proper treatment in the early postop period, then it's unlikely that you've had a recurrence a year later. If you sense that something is different, I recommend scheduling a follow up appointment with your plastic surgeon to address your concerns. Thank you for sharing your concerns. Best wishes.

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