Seroma is back after two years?

Question

Two years ago I got a tummy tuck and ended up with a seroma. My PS drained it and it finally went away. Well, after two years I noticed it came back and had a bulge. I went back to my PS and he drained 75cc and having me to come back each week until it goes away. Should he be taking more aggressive approaches? This is frustrating. Is this going to ever go away completely? Should he do a revision for the bulge? There's pain but he said to take a Motrin. He blew me off. Should I get a 2nd opinion?

Larry C. Leverett, MD, FACS · Answer

Good Day lovingmesumu01:  Your problem is infrequent but not unheard of. Recurrent/persistent seromas are handled primarily with serial aspirations, sometimes 2-3 times per week. The trend is to keep going as long as the volumes are getting less. If, however, large volumes persist, then there are other options including but not limited to inserting a drain(s), sclerosing the space (bursa), like a chemical ablating injection,  so that it sticks to itself, or ultimately, returning to the OR to have the Pseudo bursa removed. The pseudo bursa will be a pocket of thick tissue that is slick on the inside, too slick to stick down. It secretes fluid till it distends and starts up again when it the fluid is sucked (aspirated) out. I have been in practice 18 years and have done that procedure twice, but only after trying the other options first. BTW, Your surgeon did not neccesarily blow you off. He/she is trying not to put you through the surgery if it can be handled conservatively.

Christopher J. Davidson, MD, FACS · Answer

Although seromas this far out are unusual, they are seen.  Your plastic surgeon is doing the right thing by starting with conservative measures.  If this fails, other options are available.

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

Seroma is back after two years?

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Seroma is back after two years?

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Everything you need to know about Tummy Tuck

Our mission is to create a world where every investment in modern beauty is Worth It.