1 Yr Post Tummy Tuck- Fluid or Air or Gas under skin

Question

Just had my 1 year pot op tummy tuck fu a few weeks ago. I expressed my concerns and was told it's nothing to be concerned about to come back in 1 year. I feel fluid or air or gas under my skin in the lower abdomen, and around my belly button feels a little squishy at times. I noticed this back in June. If I pressed on it, it literally made a crackle noise and still does. It does come and go, and sometimes I can massage it away. What is this? Should I be concerned? Will it ever go away?

J. Timothy Katzen, MD, FACS · Answer

Hello, and thank you for your question regarding unusual sensations following your tummy tuck. At one year post-op, these sensations can be concerning, but they may not necessarily indicate a serious problem. Let’s break this down.

The sensation of "crackling" or "squishy" areas under the skin is often associated with two possibilities:

Residual Seroma:
A seroma is a collection of fluid that can occur after surgery. While most seromas resolve within the first few months post-op, some may persist or return intermittently, especially with activities that strain the abdominal area. If the fluid is compressible and can be "massaged away," this could indicate a mild seroma.

Subcutaneous Emphysema or Air Trapping:
While rare after a tummy tuck, trapped air (subcutaneous emphysema) could explain the crackling or popping sensation. This could occur if there was a minor disruption in healing that allowed air to become trapped under the skin. However, this is typically identified earlier in the healing process.

What You Can Do:
Follow Up: While your surgeon may not be concerned, it’s important to monitor any changes. If the sensations worsen or are accompanied by swelling, redness, pain, or fever, contact your surgeon immediately, as these could indicate infection or another issue.
Imaging: You might benefit from an ultrasound to rule out any residual seroma or other abnormalities. If your surgeon isn’t planning to evaluate this soon, you may request a referral for diagnostic imaging.
Compression Garments: Wearing a compression garment may help minimize fluid accumulation and alleviate the squishy sensation.
Gentle Massage: If massaging the area helps redistribute the sensation, it could suggest the fluid is non-threatening and will eventually resolve as the body reabsorbs it.
Long-Term Outlook:
If it is a seroma or minor tissue irregularity, it may resolve completely over time. However, persistent symptoms beyond 18–24 months may require minor intervention, such as aspiration of fluid or even surgical correction.

I hope this helps clarify your concerns. While it’s likely not urgent, staying proactive with monitoring and follow-up will help ensure optimal recovery.

Sincerely,
Dr. Katzen

Afet Oncel Bozkurt, MD, FEBOPRAS · Answer

Hello, Is it possible to post your photos of the area? Actually a physical consultation may be needed in order to determine if you have any problems

Chet Mays, MD · Answer

Thank you for your inquiry! To answer this question with accuracy, we would need to see you in person to be able to assess your abdomen post tummy tuck. We would love to meet with you to discuss your options. Schedule a consultation with a Board-Certified Plastic Surgeon to help you reach your goals.

Daniel Barrett, MD · Answer

Dear Thoughtful312218,

I understand your concern. However, without a proper assessment, it would be difficult to determine what is 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

Daniel Careaga, MD · Answer

there are essentially two things that can cause what you’re feeling after a tummy tuck. One would be a hernia. A hernia is a hole, or defect of the abdominal wall in which intestines can sometimes poke through underneath the skin, causing the feeling of air or gas when you touch it. A hernia is very unlikely after a tummy tuck because at no point does the surgeon actually have to go into the abdominal cavity. If a hernia was not present initially, it will not be present after a tummy tuck. The second and most likely possibility is known as a seroma. A seroma is a fluid collection that can occur between the skin and the abdominal muscles. these are fairly common after tummy tuck surgery and they’re easily treated by removing the fluid through a needle. If the fluid is not completely removed or if it returns and is not removed the body can wall off, forming like a cyst. Once this happens, you most likely have to explore and remove the cyst with the fluid inside to correct it. An ultrasound would be a good diagnostic test to start with to differentiate between a hernia and a retained seroma.

Rajaie Hazboun, MD, MBA · Answer

Thank you for posting your question here!My answer will be based on the limited information provided , for a detailed and personalized plan please consult with your plastic surgeon.
I am sorry that you are dealing with this issue, Since you are a year out from surgery you should be around where your final result is , if you feel a fluid collection it is unlikely that this will resolve and might have turned into a chronic seroma , I would raise my concerns with your surgeon and ask for an ultrasound if indicated to confirm the presence of the seroma, and if confirmed there are multiple ways of dealing with a chronic seroma that is likely encapsulated by now , ranging from draining and sclerosis to excision .I hope this helps, best of luck!

Agustina Hilario Duran, MD · Answer

Feeling fluid, air, or gas under the skin a year after a tummy tuck isn’t typical, though it might not always be a serious concern. The squishy sensation and crackling noise you describe sound like crepitus, which can happen when air gets trapped under the skin, but this usually occurs early in healing, not a year later. Another possibility is a lingering seroma, a pocket of fluid that sometimes persists or reforms after surgery. 
Since you mentioned it comes and goes and can be massaged away, it might be a small fluid pocket shifting around. However, if it's been happening since June and still continues, it’s worth getting a second opinion from another surgeon if your current doctor isn’t concerned. Persistent fluid or air under the skin could indicate an issue with healing or scar tissue. An ultrasound or further evaluation may help determine the exact cause and whether it will resolve on its own.

Connie Hiers, MD, FACS · Answer

You would not have gas at this time because it would have absorbed. However, you still could have a seroma or fluid present. Ask your surgeon to get an ultrasound of your abdomen to check for fluid.

Camille Cash, MD · Answer

The sensations that you are experiencing could be trapped fluid or gas, though at one year post op this should be minimal at most.  An ultrasound can be performed by your surgeon to check for this.  Massage, as you suggested, may help and it should resolve over time.

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