Considering reconstruction of buttock after seroma removal. Does a seroma capsule need to be entirely excised?

Dear Sincere453190,
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

Hello @Sincere453190, thank you for your question. Generally, when gluteal prosthesis are removed, seromas are very long and last for a long time. There are several reasons why they occur, one of them is associated with the fact that the area is very cold and has low vascularization; tends to accumulate fluids because its drainage center is not as close as they are in other parts of the body and if we add that there may be capsules or adhesions still there is more reason. Only the capsule could be the cause of the seroma. You need to have an ultrasound and study what is causing the seroma. It is advisable not to seed fat, until the seroma ceases to exist. Best wishes! Alan Gonzalez MD, FACS. International Federation for Adipose Therapeutics and Science” Member (IFATS), American Society of Plastic Surgery Member (ASPS), Colombian Society of Plastic Surgery member (SCCP)

Unfortunately, it is best to wait until seroma is completely gone. Resection of capsule is good way to treat chronic seroma but due to a limitted exposure (smaller incision, scar) it may not be always achived 100%. It is best to wait until issue is resolved, even if it requires additional surgery. Hope this helps. Good luck.

Hi, Sincere453190! Thank you for your question.
In some cases the injected fat may not succeed to live and accumulate in a certain place causing a liquid mass. This results in a capsule with seroma inside. The first attempt we do is to aspirate the seroma (and insert a drain if necessary) and apply a pressure garment to obliterate the potential space. If this does not solve the problem, then surgical excision of the mass with its capsule is necessary. Subtotal excision of the capsule usually results with complete cure, however the remaining capsule may still produce seroma in some circumstances.
So my recommendation is that you wait until the seroma problem is solved, and give an interval for your butt to have its last shape, then have your revision BBL:

This was my initial texted response, "I do many "fixing" of buttock deformities. You will need a few operations. First ex/incisional drainage of seroma pocket. Than 2-4 months healing with intense massaging. Finally lipo with fat grafting to give both buttock symmetry and a pleasing appearance. See private message." Attempt to removal the total seroma pocket capsule would leave a long mid buttock scar. I prefer my method to try to avid any buttock incision/scars...

Did your surgeon not put in a drain after exercising the capsule?
A drain is 100% necessary or their seroma will reform.
If a drain was not placed and then get a consultation to an interventional radiologist and have them place a drain without needing open surgery.
If you let fluid build up long enough you’ll end up with a second Chronic seroma .
Was the surgeon a plastic surgeon?
If you’re not sure what to do and get a second opinion consultation from another surgeon.
Best,
Mats Hagstrom MD

Hi and welcome to our forum!I'm sorry to hear of your difficulties. A seroma is a collection of tissue fluid accumulating at the operative site and is caused by injury to the soft tissues. When blood vessels and lymphatics get damaged through the normal course of an operative procedure or following injury, the body mounts an inflammatory response, resulting in the production of clear fluid. Normally, the body absorbs this fluid, but, if excessive, it will accumulate and create a seroma.Small seromas will naturally resorb, but larger seromas require drainage. Serial needle aspirations may be required. If repeated aspirations fail to control the seroma, a drain is placed and is usually left in place until the drainage subsides. Sclerosing solutions (we employ doxycycline) can be introduced through the drain to create scar which will retard fluid accumulation. If the seroma persists for more than several months, it may develop thickened walls. In unusual instances, surgical excision of the tissue making up the walls of the seroma is required. Complete excision is usually required, but every circumstance is different. Closing the resulting defect with a quilt like technique appears to be of benefit.Continue follow up with your plastic surgeon.Best wishes...