6 months post op - should I be concerned about tissue edema? (photos)

Question

Hello I had a tummy tuck about 6 months ago. I had many complicatiosI started bleeding from one of the drain sites about 10 Days after surgery and 4 days after having the drain removed. Took myself up to ED as I was unable to stop the bleeding and was told my heamaglobin was down to 65 and I had to have 2 blood transfusions. I spent another 3 days in hospital and had a drain inserted into my abdomen as I then had seromas. I had about 500mls of brown blood drained over a few days and got staph.

J. Timothy Katzen, MD, FACS · Answer

Dear Reneem81,

Thank you for reaching out with your concerns regarding tissue edema six months after your tummy tuck, and for providing your detailed history and photos.

Based on the information, it does appear that you still have swelling post your tummy tuck. This swelling may be related to your postoperative complications such as hematoma and seroma. To gain a clearer understanding of the situation, I recommend undergoing diagnostic tests like an ultrasound or even a CT scan. These tests will help determine whether you have fluid pockets or if it's merely edema.

If the results indicate edema, using compression garments and undergoing Lymphatic Massage may be beneficial. On the other hand, if it's not strictly edema and there's presence of abdominal fat, addressing it through diet, exercise, Ozempic, or even liposuction could be potential solutions.

I hope this helps clarify your concerns regarding the tissue edema six months post tummy tuck, especially in light of the complications you experienced, including postoperative anemia, hematoma, and seroma.

Wishing you the best as you navigate this phase of your postoperative journey.

Sincerely,
Dr. Katzen

Semih Yildiz, MD, FEPOBRAS · Answer

At six months, some swelling and firmness can still improve, but your history of significant bleeding, seromas, a drain reinserted, and staph infection makes this worth a careful in-person review. In the photos, there is lower abdominal fullness/asymmetry and scar-area changes; this could be edema, scar tissue/fibrosis, residual fluid, or contour change, and photos alone cannot separate these reliably.

I would ask your treating surgeon, or another board-certified plastic surgeon if needed, to examine you and consider an ultrasound to check for any persistent seroma, organized fluid, or hematoma. If there is no active infection or fluid collection, conservative care such as time, compression if advised, scar massage, and supervised lymphatic drainage may help. Increasing redness, warmth, drainage, fever, worsening pain, or rapidly increasing swelling should be checked urgently because of your prior infection history.

Ronald J. Edelson, MD · Answer

There is the possibility of a persistent seroma which is dimple to diagnose. Otherwise there is certainly room for improvement with a revision

Erika Sato, MD, FACS · Answer

Have you gained weight since the surgery? If so, this can make things above the scar look puffy. It does not take much. A few pounds can look bad. BUT if you have not, the puffiness may still resolve with time as your healing didn't really start until after all of your complications resolved. I don't love your scar. It loos like a "'w". I would consider revising this with more lipo if things do not look the way you hoped by your one year mark.

Connie Hiers, MD, FACS · Answer

I would suggest going back to your surgeon and see if the residual fullness is fat. If so, liposuction can be done now.

Camille Cash, MD · Answer

I'm sorry to hear of all the issues you've encountered since your tummy tuck.  To begin an assessment of your abdomen is needed.  Determination of the nature of the fullness is needed in order to correctly address it.  I encourage you to visit with your surgeon or another board certified plastic surgeon near you for an evaluation.

Mats Hagstrom, MD (license on probation) · Answer

It sounds like your postoperative experience was challenging and unfortunate. Based on what you describe, I think the first step should be to make sure you don’t have a chronic encapsulated seroma. This can usually be detected on examination, but an ultrasound is very accurate safe and relatively straightforward. Usually the management of complications after cosmetic surgery is not considered cosmetic and usually covered by medical insurance. Talk to your plastic surgeon about getting an assessment regarding your abdominal wall to make sure there are no long-term fluid collections.
 For Lisa Ramos can be treated by placing a drain or draining them on a regular basis. Once capsulated, the management is different, and generally requires open excision of the capsule with the placement of a drain.
There may also be a mismatch between the thickness of subcutaneous fat at your incision line. Most people have significantly thicker layers of subcutaneous fat and their mid abdomen. Then they do at the groin. When the skin in between is removed, it can create a mismatch between the thickness of subcutaneous fat, creating a step off at the Incision line unless the fat layer is adjusted it during the procedure. 
The first step is to get an understanding of if this represents subcutaneous, fat or a fluid collection or both.
If you’re not getting the care you need from your provider, then consider having a few in person second opinion consultations.
I’m going to assume that your doctor or doctors valuated you for any bleeding disorder when you were hospitalized and required blood transfusions. If that wasn’t done or hasn’t been done in the past and you should probably talk to your primary care doctor about a referral to the hematologist so you know if you have a bleeding disorder or not.
Best,
Mats Hagstrom, MD

6 months post op - should I be concerned about tissue edema? (photos)

Answers (7)

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