Painful Lump/ridge After Tummy Tuck And Hematoma? (photo)

Question

I am currently 3 weeks and 3 days post op from a full tummy tuck. Right after the surgery I had a hematoma on my left side. Ever since I have had a hard, painful, lump/ridge along & above the incision on my left side. I will include a picture but it's not really something you can SEE, its just a firm, painful mass. My PS says "it could be anything". I would really appreciate some answers. Thank you.

Erez Sternberg, MD · Answer

I have seen this happen a few times after a tummy tuck procedure.  The question is whether you have a seroma (fluid) or hematoma (blood) under the skin.  If your surgeon thinks this is residual blood (hematoma) the best course of action is to wait for at least six weeks prior to going back with liposuction under local anesthesia and suctioning the liquified blood our of the wound. If you go back too early the dried blood is too hard to suck out, and if you wait too long it can calcify and harden under the skin and leave a permanent mass.

	  In the meantime, use a warm heat pad and massage the area to help with breaking down the blood clot.  Hope this helps.

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

Richard Kofkoff, MD, FACS (retired) · Answer

I suspect that since you state you had a hematoma then your mass is most likely residual blood. My experience is that relatively small hematomas typically will resolve over time and not necessarily require any treatment. Massage can be helpful. Heat may be of benefit but you need to check with your physician first to be certain you don't risk burning your numb skin or create other problems. Work with your doctor and I think your final result will not be significantly affected by this issue.

Painful Lump/ridge After Tummy Tuck And Hematoma? (photo)

Answers (3)

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