Pseudo-bursa? Procedure & Recovery. 8 Months Out From TT? (photo)

Question

8 months out from a Tummy Tuck with about 12 needle aspirations for persistent seromas. Very uncomfortable scar tissue and my belly is distended 8" with a water balloon wave and hard knots. The surface is uneven and I am MISERABLE! I've gone back to my doc over the months & keep being told to wait for it to get better. I'm going back tomorrow & am scared, sad & frustrated. Would an ultrasound show what's going on rather than blind aspirations. Do I insist on surgery to fix it or go elsewhere?

Remus Repta, MD · Answer

Hello,

Thank you for the question and the photo.  It sounds like you have a "pseudobursa".  A pseudobursa is scar tissue that has formed around a seroma (most often).  If the pseudobursa is thick and or there is persistent fluid within it it will cause a fullness or bulge to be present.  Although there are some who recommend liposuction or injection of the pseudobursa as an attempt to make it less obvious the only full correction and often the best way to take care of it is through complete removal.  To accomplish this part of all of the incision should be opened.  The pseudobursa has two layers and both layers should be removed.  If there is a source for the seroma and subsequently pseudobursa creation it should be removed.  This can sometime be permanent sutures that were used to tighten the abdominal wall (ethibond).  Once all of this is done a drain should be placed and an abdominal binder should be worn diligently.  At this time you may elect to have your plastic surgeon obtain a CT scan or an ultrasound to determine if a pseudobursa is present but often the history and physical exam alone are enough.  My recommendation for treatment is for full removal which means you and your plastic surgeon should prepare, if needed during the day of surgery, to perform a full tummy tuck revision.  The link below is from my blog and contains information about pseudobursa that you may find helpful.

All the best,

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

Darryl J. Blinski, MD · Answer

Sure obtain a scan or a non invasive sonogram to demonstrate if there is a "sac" or is it a lax muscle repair.

Jourdan Gottlieb, MD · Answer

Thank for the question, sorry for the problem you are having. 

	At this late stage it will probably be most effective to have the pseudo-bursa (the pocket that has formed which contains the fluid) excised. This procedure is done in the operating room under anesthesia, and is similar in magnitude to the original tummy tuck.

	I cannot tell from the narrative if either of the following has been tried:

	
		Placement of a drain, and compression
	
		Sclerosis--insertion of  a material (betadine, tetracycline, alcohol, etc.) to try to make the walls of the bursa stick together and stop secreting the fluid.


	I think those are not too likely to work at this stage, but certainly are simpler than surgery, and might be worth a try .An ultrasound will show fluid but not much else that would be useful in planning therapy.

	Good luck and best wishes.

Pseudo-bursa? Procedure & Recovery. 8 Months Out From TT? (photo)

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Answer: Pseudo-bursa? 8 Months Out From TT

Answer: Pseudo-bursa? 8 Months Out From TT

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Pseudo-bursa? Procedure & Recovery. 8 Months Out From TT? (photo)

Answers (4)

Answer: Pseudo-bursa? 8 Months Out From TT

Answer: Pseudo-bursa? 8 Months Out From TT

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Everything you need to know about Tummy Tuck

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