Possible seroma after drainless full tummy tuck. Should I be concerned?

Question

On my 12 day post op, doctor suspected possible seroma. He attempted fluid removal with needle in the area 3 times. No fluid aspired. He concluded that it's just swelling. Can this still be a seroma? Should I be concerned?

Mark A. Deuber, MD · Answer

Most surgeons place drains after a TT. The few that don't use quilting sutures to close off the space between the abdominal flap and the abdominal wall. In either case seromas can occur. They are usually diagnosed with clinical exam with discrete swelling and a fluid wave. They are then aspirated with a needle and syringe or closed Seroma drainsge system. Sometimes aspiration is unsuccessful (the pocket isn't successfully reached with the needle). At this point, the choices are wait and see what happens or do an imaging study to evaluate. Imaging can be CT scan or ultrasound. With ultrasound, a catheter csn be placed under the ultrasound guidance. But wait and see is also ok. Small seromas can go away; or they can turn into big seromas which are easier to drain without imaging. Your surgeon will help you figure out which way is best to go in any given situation.

Jed H. Horowitz, MD, FACS · Answer

A seroma is certainly possible following a #drainless tummy tuck. It's difficult to confirm if such is actually occurring in your case. without any photos to view and online. If at any time you have any concern at all about your healing process, you should not hesitate to contact your surgeon. Your surgeon will be able to determine if you are in fact experiencing #seroma at this point and can work with you to resolve it.

Elizabeth Slass Lee, MD · Answer

Drain free abdominoplasty is a relatively new way to do tummy tuck surgery. But seroma can form after surgery whether or not drains are used. The most important thing is that you have good follow up with your surgeon. If for some reason you are not sure about that relationship you can always get a second opinion. Choose someone certified by the American Board of Plastic Surgery.

Farah Naz Khan, MD · Answer

This could still be a seroma and it's best to keep monitoring that area of increased swelling. Also, ask to see your operating surgeon on a regular basis so he can properly examine and evaluate you in person. Continue following your plastic surgeon's post op protocol for the best possible results. Good luck!

Ali Mosharrafa, MD · Answer

The definitive diagnostic tool to answer your question is an abdominal ultrasound.  It is simple, noninvasive, and if a fluid collection id found, it can be drained simultaneously.  I would recommend pursuing this if you are concerned.  Hope this helps.Dr. Ali Mosharrafa

Hisham Seify, MD, PhD, FACS · Answer

Seroma could occur whether drains were used or not. The best option is to continue follow up with your plastic surgeon.

Kamran Efendioglu, MD · Answer

Hi. Seroma risk is relatively high after a full abdominoplasty operation. Rates can be as high as 40% which makes the utilization of drains mandatory. There is no justifiable reason for not using the drains. Even the patient discomfort. No patient would prefer health risks over the temporary discomfort. There is a chance that there is no seroma with no drains and there is a chance of seroma despite the drains. But there's no argue that drain decrease the risks significantly.If the seroma fluid is not drained it may cause excessive skin stretching and resulting loose skin as well as calcification (stiff abdominal skin and fat) at later stage.Diagnosis can be made with an ultrasonographic exam. Abdominal CT is rarely needed.Fluid accumulates in lacunes between the muscle/fascia and fat. Usually it is not possible to drain fluid with needle. A small incision on the operation scar followed by an insertion of a drains works the most. This can be performed under local anesthesia.Confirmation of diagnosis is essential for further workup.I believe your doctor knows what's he is doing. If you're not satisfied you can always ask for a second opinion. Good luckMy best

Mats Hagstrom, MD (license on probation) · Answer

Some surgeons do not use drains during abdominoplasties. Those who do not typically put multiple sutures to hold layers together, preventing fluid buildup from happening.It is still, however, possible to form a seroma.It is also possible to miss the fluid collection when doing a blind aspiration with a needle.The most accurate assessment is to have an ultrasound done.They are safe, simple and covered by insurance if you have medical insurance.Continue to follow up with your plastic surgeon and consider asking if he or she thinks you should get an ultrasound.Best of luck,Mats Hagstrom, M.D.

Maan Kattash, MD, FRCS, FACS - Account Suspended · Answer

Seromas can occur to the best hands regardless of the abdominoplasty technique used. It is diagnosed by clinical examination. The only way to confirm the presence of a seroma is a CT scan or an MRI. For now, I recommend adhering to your follow ups and sharing your concerns with your surgeon.

Possible seroma after drainless full tummy tuck. Should I be concerned?

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