Seroma needs surgery: Will it leave a dent in the skin surface?

Question

I have a seroma folowing a fleur de lys tummy tuck 3 months ago. My surgeon says will have to be left or removed with surgery. It is about the size of a goose egg, not painful and makes me look like I have a bit of a tummy still. I don't want more surgery but it is a bit uncomfortable when standing without any compression so I rarely forget its there. A further issue for me is that my surgeon says removal will leave a dent so I am imagining a strange shaped tummy if it is removed.

Antoine A. Hallak, MD, FACS · Answer

In about 1% of tummy tucks, after the drain is removed, the body
produces too much fluid and the fluid starts accumulating.  This is called
a seroma and this extra fluid needs to be drained.

Fortunately for the tummy tuck patient, the drainage procedure
is typically simple.  A small needle is inserted into the collection, and
the fluid is gently aspirated.  Seromas typically disappear after anywhere
between 2-5 aspirations.

Seromas do not typically affect the final outcome of the
surgery, but do require several more visits to the office to remove this extra
fluid.

Compression after aspiration of the seroma is recommended.

The seroma fluid will appear blood tinged in the first few weeks
after surgery, or will be clear if the seroma occurs later in the course. 
This is an important distinction between a seroma, which is a fluid
accumulation, and a hemotoma, which is a blood collection.  Both are
treatable, but a hematoma is a little harder to aspirate and may have a larger
risk of infection because bacteria grows better in blood than in the seroma.

William T. Stoeckel, MD · Answer

Sorry to hear about the seroma. They can be very frustrating indeed. Your surgeon has had the benefit of completing your surgery and seeing you in follow up. I would trust his opinion and his suggestions for the course of action for treatment. My treatment algorithm for seromas include:1. percutaneous aspiration: this can be done in the office and involves using an 18 guage needle and 60 cc syringe to puncture the seroma pocket and aspirate the seroma fluid. This often needs to be done several times, sometimes several times a week. If the amount of fluid removed continues to be less and less with each aspiration, then I would continue until the seroma is gone. 2. placement of a drain: they make a small catheter that is very easy to use called a seromacath that can also be placed in the office. This can allow for continuous drainage of the seroma. If the drainage decreases with time and the seroma "dries up", the catheter can be removed. 3. sclerosing agent: if a drain has been placed but the seroma fluid continues to collect, a sclerosing agent such as doxycyline can be infiltrated into the seroma pocket through the drain. The drain is then clamped and the agent allowed bathe the pocket for 1-2 hours. The drain is then opened again. The sclerosing agent can sometimes cause the walls of the seroma pocket to collapse and stick together and eliminate the pocket4. surgical removal of the seroma: if none of the above treatments work, the seroma can be excised. The entire wall of the seroma pocket needs to be removed to prevent recurrence. In your case, I would try to remove some additional skin that overlies the seroma so that the end result does not look like a "dent". This may or may not be possible. But if you are noticing some additional swelling from the seroma, it probably is. Best of luck with this annoying problem.

Brooke R. Seckel, MD, FACS (retired) · Answer

Thank you for your question.  It is very important that you follow your surgeons advice.  It is true that when a seroma cavity is removed the skin over the seroma can be depressed.  Most often this depression or dent is not severe and is more acceptable than leaving the seroma cavity in place.

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

Seromas are treated with repeated aspiration, drainage either by re-inserting a drain or surgically..... and wearing the compression garment. You have the unfortunate scenario that can occur to any surgeon who does body work.I think your priority at this point is to deal with the seroma for now and worry about the contour deformity that may occur as a secondary stage. You may not develop a "dent" at all. OR, should you develop one; then there many ways to deal with it. Regardless, you may have to wait at least 3 months to allow the skin and tissues to settle down and heal prior having surgery to correct it. Good Luck.

Seroma needs surgery: Will it leave a dent in the skin surface?

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Answer: Seroma needs surgery: Will it leave a dent ?

Answer: Seroma needs surgery: Will it leave a dent ?

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Seroma needs surgery: Will it leave a dent in the skin surface?

Answers (4)

Answer: Seroma needs surgery: Will it leave a dent ?

Answer: Seroma needs surgery: Will it leave a dent ?

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