In need second opinion for wearing compression garment (Photo)

Thank you for your question about what to do with fluid build-up 25 days after a tummy tuck. First, I would treat one problem at a time. In my opinion, I still think there's fluid left over. Especially if you see a fluid wave, this will not go away. This needs intervention. If your surgeon cannot find it in the office, I would suggest you be sent to a radiologist to be found with an ultrasound and a drain placed. Once the drainage is minimal, then the drain can. Be removed. Now, while the drain is in and after the drain is removed. I would suggest you wear your compression garment. At this point, a compression garment will not hinder your healing or area of necrosis. Therefore, you must address your seroma first and continue wearing your compression garment to flatten the cavity the seroma has created. I hope this question helps you answer your question about what to do with fluid build-up 25 days after tummy tuck
If you have any more questions regarding the tummy tuck or abdominoplasty, please contact my office. Since an abdominoplasty can be a difficult procedure, please seek an experienced, board certified plastic surgeon with significant experience performing tummy tucks. Do your research. Make sure your chosen plastic surgeon has performed at least 100 abdominoplasties. Make sure they have the before and after pictures to prove it. Carefully examine their before and after pictures and check their reviews on RealSelf. Good luck! Sincerely, Dr. Katzen. (“Verified” Plastic Surgeon, President of the American Society of Bariatric Plastic Surgeons, Certified by the American Board of Plastic Surgery, Fellow of the International Society of Aesthetic Plastic Surgery, American College of Surgery, International College of Surgery, and American Board of Metabolic and Bariatric Surgery, and ​member of the American Society of Plastic Surgery, American Academy of Cosmetic Surgery and RealSelf Hall of Fame.)

Thank you for your question regarding wearing a compression garment post op tummy tuck and for including a photo.

The compression garment is meant to be worn to help with swelling and stability after surgery.

Hope this helps!

The best advice I can give you is to follow your surgeons advice. That said, proper compression always helps control seroma. Just make sure it is not overly tight.

Best of luck,
Dr. Miguel Mota

Further compression as long as not excessively tight will not cause further necrosis. This has already declared itself and will need to be revised. Compression may help with the seroma.

Dear MelissaMe95,
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

Make sure your compression is not too tight or the healing will be hindered. You can always wear compression above the area as well.

I am sorry that you are suffering from this unfortunate however common complication with seromas after abdominoplasty. I agree with her surgeon that a snug fitting compression garment, As long as it is not too tight to breathe, can help you in this case. It can help prevent additional swelling from forming in the tissue as well as can help keep the pocket where the fluid is accumulating closed.

It is not unusual to have fluid remaining after a drain is removed. It can be similar to a sponge that holds water but one cannot “tap” it out. But a fluid wave can suggest the fluid is accessible even if attempts fails. Consider requesting and ultrasound to visualize and even drain the fluid. Easily obtained from an order to an outpatient radiology center. Compression is often vital to results. Especially if any liposuction has been performed. It’s on a timeframe of months but you’re already nearly 1 month into recovery. The area of necrosis. The dark area is already “declared” and would not be significantly impacted by compression. Therefore I would consider using compression for the benefits. The wounded dark area is a scab and will fall away revealing an open wound soon. That will need to be manages and can be brought to heal with little intervention. The resultant scar may not be perfect but that can be addressed. In the end compression is important and consider its use for the overall end result. Ask you surgeon regarding thoughts and defer to their opinion.

It is best to follow your surgeon's instructions and discuss any concerns or questions with her/him. Do not be afraid to ask "why". It is important that you are comfortable and confident in your recovery. The compression garment is helpful to control swelling and seroma formation. It is important that the garment fits properly. You may want to bring it with you to your appointment for your surgeon to evaluate the fit.

It’s not appropriate for us to give you input on postoperative care. That is not really second opinion material.
It would be inappropriate for me to tell you to do something different than what your surgeon recommended.
I can tell you that in my experience when patients have a seroma I drain them on a daily basis until all the fluid comes out. I sometimes use a very small Liposuction cannula connected to a vacuum pump to remove the fluid and that is often very effective. personally I drain seroma fluids every day I’m in the office and try to never go more than three days without draining them in order to minimize the formation of a capsule around the fluid collection.
I have also sent patients to interventional radiologists to have a drain placed which is usually covered by medical insurance and very effective(hint).
I don’t think wearing a compression garment will affect the skin necrosis. You will need to have the necrotic skin removed and a 25 days it’s probably about time for that.
The tissues that are alive have differentiated clearly from those that are dead and may now be time to remove the dead tissue and begin wound care. That decision is up to your surgeon.
It’s possible that in the necrotic tissue debridement procedure will allow the fluid to drain from the fluid collection and that may simply resolve the problem by itself.
Applying a vac or “Vacuum assisted closure” can rapidly accelerate wound healing and if the wound is connected to the fluid collection will then automatically take care of the seroma.
If you feel like your surgeon is not managing your care sufficiently then seek a proper in person consultation with another local board-certified plastic surgeon to take over your posterity of care. Most likely plastic surgeons will tell you to go back to your doctor since he is the one who did your procedure and is not doing anything wrong. Some may be willing to take over your postoperative care you’ll simply need to ask if you feel the need.
Personally I’m quite hands-on and aggressive with seromas because if left untreated they become a chronic encapsulated seromas that can never be treated by aspiration alone.
With time things typically work out but seromas do have a window of opportunity where they can be treated with proper drainage which needs to be frequent and aggressive if drain is not placed. if that is not done they will encapsulate and then can only be removed with open surgery.
All plastic surgeons should be trained and competent in dealing with a seroma.
Everybody does things a little differently. Your surgeon is responsible for your outcome just like you are responsible for choosing that surgeon.
Follow up with your provider and if you feel the need to get a proper second opinion scheduled those as in person consultations.
Best,
Mats Hagstrom MD