What is the Best Way to Drain Seromas Post Tummy Tuck?

Aspiration is probably the most common method of treating a seroma accumulation after a tummy tuck. This is typically repeated on a weekly or biweekly basis.

Seroma can occur with tummy tuck surgery.  It is usually managed with aspiration of the seroma continued use of a compression garment and limiting activity.  If aspirations become recurrent then management may need to proceed to a replacement of a drain.  Very rarely does the management evolve to the point of surgery or the use of medicines injected to produce scarring of the seroma pocket.

Dr. ES

Seroma is an accumulation of fluid called serum that can occur after surgery. The purpose of drains placed at the time of an operation is to pull out the fluid that collects early on. As you heal, the production of serum in the surgical area decreases and the drains can be removed. Sometimes the drains come out and serum production continues, a collection of serum forms under the healed skin and needs to be removed. The most common way of treating a seroma is by removal with a needle placed through the skin into the collection of fluid. The serum should be pulled into a syringe through this needle until no more can be removed. In my office, I see the patient every 2-3 days and repeat this procedure until there is no more seroma visible. It is my experience that within a week to 10 days of this treatment, the problem resolves.

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

Needle aspiration or open incision line mare both vaible options. Sometimes even a drain needs to be placed. If there is an infection you will need antibiotics. If the seroma is there a long time, your incision will need to be partially open, the fluids and capsule removed and closed.

Despite all the claims out there, there is no proven way to prevent drainage after a Tummy Tuck. As a result, drains are extremely helpful. If a seroma (fluid collection) occurs after drain removal, it is best drained by placing a needle and syringe percutaneously (through the skin) and aspirating the fluid. I prefer to see my patients every 3-4 days because by frequent aspirations the seroma is kept small and the opposite walls are in contact with one another leading to healing. I do not understand the logic of repeatedly opening ?the the incision or ? the former drain opening and thereby risk infection and or poor scarring.