Calcified seroma - is it OK to leave the capsule alone?

Question

I had surgery last Nov and 3 mos ago I noticed that I had a seroma. My plastic surgeon is very far so I have been going to the radiology Dept and having aspirations. I started with 90ccs of fluid removed, and the fluid has gone down every two weeks I’ve had 5 aspirations. My last one I only had 13 cc of fluid. The IR dr told me that should be it, not to mess with surgery to remove the capsule. My stomach is tight. Is it OK to leave the capsule alone? Any other recommendations other than surgery?

Camille Cash, MD · Answer

It should be okay to leave the seroma capsule alone unless it is causing other issues.  However, it is best that you visit with a board certified plastic surgeon near you for an in person evaluation since you are unable to meet with your surgeon.

J. Timothy Katzen, MD, FACS · Answer

Thank you for your question regarding a calcified seroma capsule after surgery. Based on your description, it sounds like your seroma has significantly reduced in fluid volume over time, which is a good sign. Here’s what you need to know about leaving the capsule intact and alternative approaches to consider.

Understanding Seroma Capsules:
When a seroma forms, the body may develop a capsule of fibrous tissue around it. Over time, this capsule can harden or calcify. A calcified seroma capsule is generally harmless unless it causes discomfort, restricts movement, or affects the appearance of the treated area. If your seroma has stabilized and the capsule isn’t causing significant issues, many surgeons recommend leaving it alone.

When It’s OK to Leave the Capsule:

If the fluid volume has significantly decreased, as in your case (down to 13 cc), and is no longer increasing.
If the capsule doesn’t cause pain, tightness, or functional limitations.
If it isn’t visibly distorting the treated area.
It’s important to continue monitoring the area for any changes, such as increased tightness, pain, or fluid reaccumulation.

Managing Tightness:
You mentioned that your stomach feels tight. This tightness could be from scar tissue, residual fluid, or the capsule itself. Gentle massage, lymphatic drainage techniques, or ultrasound therapy may help improve the tightness. Always consult your plastic surgeon or a qualified specialist before trying these therapies.

Surgical Removal of the Capsule:
Surgical removal of the capsule may be recommended in rare cases where:

The seroma recurs persistently.
The capsule causes discomfort, restricts movement, or affects appearance.
The area is at risk of infection or other complications.
Next Steps:
Since your seroma is resolving and your fluid levels are low, it’s likely that the capsule will not cause significant problems. However, it’s still important to follow up with your plastic surgeon, even if they are far away, to ensure no additional intervention is needed.

Leaving the capsule alone is often a safe option, but close monitoring and open communication with your surgeon will provide the best guidance for your situation. I hope this helps to address your concerns, and I wish you a smooth recovery moving forward.

Sincerely,
Dr. Katzen

J. Jason Wendel, MD, FACS · Answer

Thank you for your question about seroma post op tummy tuck.

For specific questions like this and about your recovery in general, it is best to speak directly with your doctor or doctor’s representative – such as his or her nurse, or the physician on call for the practice.

You will likely get many differing opinions from members of the RealSelf Community, but they have not personally seen or examined you. Nobody should know you or your unique set of circumstances better than your doctor.

If you feel you are not being listened to or you are doubting your doctor’s recommendations, then it is certainly within your rights to seek a second opinion and get the advice from another board certified physician. This should be done through an in-person consultation with a thorough evaluation, including a review of your history, review of all prior treatment and with a physical examination.

Best Wishes.

Ronald J. Edelson, MD · Answer

After the seroma is resolved there will be thickness in the area. The radiologist is right. Just leave it alone and it will gradually soften up

Daniel Barrett, MD · Answer

Dear Lily2013,
I understand your concern. However, without a proper assessment, it would be difficult to determine what went wrong. It is best that you visit your plastic surgeon for further assessment or ask for a second opinion. Only after a 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

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