Surgery 2 days ago to remove pseudobursa and persistent seroma, quilt sutures with no drains and now accumulating fluid. (photo)

You for your picture. This is not an emergency so I will not go to the ER. Definitely you should see your plastic surgeon as soon as you possibly can. A drain may need to be placed in addition to your previous treatment.

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

Dear Pshelp43,It does appear that you have a seroma.  Your plastic surgeon will be able to confirm this when he/she examines you.  You may want to discuss the placement of a drain instead of periodic needle aspiration of the seroma.  The drain will allow continuous seroma removal.  I would also wear your abdominal binder religiously.  As for going to the ER I do not think its necessary unless you are showing signs of infection or wound separation.All the best,Dr. Remus Repta

I do not recommend going to the ER. You may be re-accumulating fluid & thus you should contact your plastic surgeon and plan to be seen relatively soon.

Unless there is pain, fever or redness I do not see urgency.  At any rate I would sooner see my own patient than have her go to the ER. All the best.