Seromas are an all too common problem following an abdominoplasty, particularly in short waisted patients. Aspiration should be done every 3-4 days aided with an elastic compression garment ( like used for liposuction) as well as an abdominal binder. The presence of a seroma slows the resolution of the lower abdominal skin swelling, so an aggressive approach is best. Using a rolled towel over the area of the seroma also increases the pressure and enhances healing. Under optimal situations, it takes approximately 3 weeks for the abdominal skin to reattach to the muscle wall. A pseudo bursa can develop despite all these techniques.
I wish you well !
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.
Pablo Prichard, MD
Thank you for your question.
It can be a concerning situation, I suggest to get some lymphatic massages. Normally these can help the excess fluid build up, drain more easily and properly.
Pseudo bursa following significant dissections are possible if healing tissue does not adhere and internal tissue surfaces become lined with slippery glistening scar. This process can occur within 2-3 weeks after surgery and is a definite consideration in your case. Your reported drained volumes exceed what I have generally seen following abdominoplasty. In the case of a pseudo bursa, sclerosing solutions may work if the seroma volumes are controlled by surgical drains and tissue is held immobile by compression garments. With a persistent and recalcitrant psuedo bursa, surgical excision of the capsule may be necessary to effect resolution. Good luck.
I think the concern is realistic. The dramatic volume is far beyond my experience, but if I were to see that then my choice of care would involve putting in a new drain. It is a simple procedure with a little local, painless, and will take care of the problem.
Thank you for your question. It sounds like your surgeon is treating you appropriately. Pseudo-bursa after seroma typically does not occur unless the seroma is prolonged over 6 weeks.
Seromas are not uncommon with tummy tuck surgeries. The more aspirations necessary to drain a recurring seroma, the more likely you will develop a pseudobursa. These are easy to remove if they do develop. However, compression, minimizing activity, and aspirations or drain replacement will be the easies and most common steps to reduce this risk of occurrence.
The best course of action is to follow your surgeon's recommendations - seromas very often resolve with serial aspirations, compression and sclerosants. Rarely does a bursa form that requires other intervention, but if it does, it can likely be treated with a very good outcome. Please address your concerns with your doctor - he or she knows your specific circumstance, and the rest of us online can only offer generalizations.
You might ask your surgeon to place one of the drains back under local. By removing the fluid as it appears, it will keep your stomach flat and encourage the space to collapse
This is a question best answered by your plastic surgeon and I would encourage you to contact them. As a general response, a seroma can theoritically develop into a pseudobursa, though this most-often happens when the seroma isn't originally recognized. Since you have a known seroma being aspirated, the general principles of frequent aspiration followed by compression should resolve it over time.