Need surgery to remove seroma? I have questions

Question

Hello doctors, Story: I had a Drainless TT on 04/04, and on 04/09 I developed a seroma. PS aspirted it multiple times, then inserted drain, then scleoring agents 3 times, and nothing worked. I am now scheduled for surgery to remove the seroma. My PS is not experienced in this complication, as he said he's never seen a seroma this persistent. I am looking for experienced surgeons in seroma removals around my area, and prices for this type of procedure.

Michele A. Shermak, MD · Answer

It sounds like the surgeon needs to open the incision, explore and place a drain. Drainless tummy tuck is not very commonly performed - some surgeons do it and market it as the patients find it appealing to not use a drain. I have not found this to be possible and I always use drains at the time of tummy tuck. Draining a seroma is not complicated and persistent seromas are something I would think any plastic surgeon has seen. Yes, it is possible the seroma will not stop with a drain placed. In that case you would be fine getting a second opinion.

Larry Weinstein, MD · Answer

Seromas or fluid collections are one of the most frequent complications of abdominoplasty. Using an abdominal binder firmly applied to the abdomen with cotton roll under neath is the protocol I use for 30 days after surgery or seroma aspiration. It is important to limit activity for 30 days after last aspiration or surgery. It takes several weeks for the Timmy skin to stick back down. Sedona excision is a simple procedure. An ultrasound, MRI or Ct scan may help to be sure of the diagnosis. Sometimes a hernia is the culprit. I have removed a late aeroma but have never considered excision before six months. It can take persistent aspirations or drains for two months with limited activity and form compression to be rid of this nasty complication. Good luck and be compliant.

Joseph Michaels, MD · Answer

Sorry to hear that you are having continued issues following your surgeries. It sounds like your surgeon has taken the appropriate steps. Seromas can occur in 5-10% of patients and even higher (up to 40-50%) in weight loss patients. The treatment for a refractory seroma is to completely excise the seroma cavity and then place and drain and use compression. You should also make sure that your protein intake is high as this will minimize the risk of fluid collections. I have had to do this procedure several times, mainly in my weight loss patients due to the increased risk. Some insurance companies may help, but many do not cover the costs of complications related to cosmetic surgery. From a cost standpoint, seeing your surgeon will be the most cost effective. I hope that this situation resolves for you.

Shlomo Widder, MD · Answer

Dear Maru,   Sorry to read about your problem. A front and side view picture would have been helpful. Your condition is very rare and I have done it once or twice in my 30 years practice. It is possible that you have developed granulomas in the seroma pocket , which cause the constant filling of the pocket with fluid. I hope that cultures were sent to the lab and came back negative.    The treatment for chronic seroma  is to excise the lining of the pocket and create raw surface that will stick and eliminate the cavity. I would recommend to leave a drain for few days, which will help the cavity to scar down and disappear.   Your best option (financially)  is to let your surgeon do it,  however, if he declines to do it , or you lost confidence in him, consult with other, local experienced board certified plastic surgeons.The procedure will take 1-2 hours, depends on the size of the cavity.                          Best of luck,                                                  Dr Widder

Adam Tattelbaum, MD · Answer

Thanks for your question. I am sorry to hear you are having issues. Seroma can be frustrating and it sounds like your PS is taking the right steps. A drainless or quilted tummy tuck is usually an effort to prevent this complication in the first place. When a seroma persists the treatment is to go back in, remove the lining of the cavity if possible or abrade it so that the tissues will stick to one another again and quilt again. If there is any permanent suture material it may need to be removed. Depending upon the location of the seroma, and the suture material used the surgery may be smaller or similar to the scope and cost of an original tummy tuck. If you have a long lasting, but dissolvable plication suture the seroma may resolve when it is gone. All PS's try to prevent seroma so I think it would be hard to find a seroma specialist. Seroma is an unfortunate risk of this type of surgery. It sounds like your PS is doing the right things and still may be your best bet.

Best wishes.

Best wishes.

Steven Wallach, MD · Answer

Often treating the seroma with repeated drainage, or drain, or sceleroisng agents  will commonly improve the situation. If after treatment this is not successful, then sometimes removing a pseudobursa is necessary.

Brian Coan, MD, FACS · Answer

Congratulations on your recent surgery and thank you for sharing your question about your post operative recovery and results after your surgery.  Final results can take 6-12 months for all the swelling to subside.  At our office here at CARE we actually see all of our surgery patients the very next day after surgery and then again at two weeks and beyond. We enjoy staying closely connected to our patients and enjoy giving the extra attention and service. Your concerns are important to discuss directly with your board certified plastic surgeon.  He or she will appreciate the open communication and will want to help you. I hope this is helpful and wish you all the very best.Your bio is very helpful, however without the benefit of knowing your full health history and an in person exam it's impossible to say for certain.  When seeking a second opinion: I would recommend you have an in person consultation with a plastic surgeon with these credentials: *Board Certified by the American Board of Plastic Surgery -- The gold star symbol*A member of the ASPS (American Society of Plastic Surgeons) -- The circle symbol*A member of the ASAPS (American Society of Aesthetic Plastic Surgeons) -- the Queen Nefertitti symbol with a Triangle  *On faculty at local plastic surgery teaching program -- in our office we are affiliated with both Duke and UNC schools of plastic surgery.    Feel free to contact our office, it would be our pleasure to answer your questions in person. I hope this is helpful and wish you all the best in your journey.  My sincere best, Brian S. Coan, MD, FACS

Praful Ramineni, MD · Answer

Persistent seromas usually need to have the capsule (shell) excised and a drain placed +/- a sclerosant.  It is rare to have another recurrence once the cavity is removed.

Need surgery to remove seroma? I have questions

Answers (8)

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