Seroma or Normal Swelling 15 Weeks After Tummy Tuck?

Question

Im at 15 weeks after tummy tuck and liposuction and I seem to have a pouch in the lower part of my belly I saw my doctor 4 weeks ago, he used a siringe to get fluid out but nothing came, he told me it would go away on its own. Im I being to impatient or should I worry?

Ryan A. Stanton, MD · Answer

Either is possible 15 weeks following a tummy tuck (or many similar operations that involve elevating tissues from there normal attachments, aka - dissecting between tissue planes). The only way to tell for sure is by physical exam (preferably by the operating surgeon who knows exactly what he/she did in surgery) and occasionally ultrasound to verify a seroma.

Dhaval M. Patel, MD · Answer

Thank you for your question,
While swelling after tummy tuck is very common I recommend you meet with your board certified plastic surgeon with any post op concerns you have so they can examine you in person and address them. 
Best Of Luck!
Dhaval Patel 
Plastic Surgeon 
Double Board Certified 
Hoffman Estates, IL 
Oakbrook, IL
Orland Park, IL
Chicago, IL

Scott C. Sattler, MD, FACS · Answer

Its impossible to diagnose a seroma with a photograph - if you and your doc perceive a 'fluid wave' when palpating the lowest part of your abdomen, then you've got a seroma . Its quite likely that you have soft tissue swelling (edema) which is not a fluid collection, simply soft tissue water that has collected in the most dependant portion of your torso and stays there because of the disrupted lymphatic channels - this edema always resolves with time. An abdominal ultrasound is a good way to diagnose a seroma that might require drainage.

Pablo Prichard, MD · Answer

Dear 57,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.Best wishes,Pablo Prichard, MD

Steven M. Lynch, MD · Answer

Hi,

	  It seems that you have swelling in the area below the belly button.  This is normal and will be worse at the end of the day.  This is due to the vessels regenerating to the redraped tissue.

	  If you did not have any fluid on aspiration, then you have fluid in the tissue like a "wet sponge". You need to be patient with this as it will get better over a years time.

	  Also too is the fact that sometimes a secondary procedure is needed to decrease the fat in this area with liposuction but you would not anticipate this discussion until you are at least a year.  Then, if this area is still a question, find out what your options would be.

Tom J. Pousti, MD · Answer

Thank you for the question.

	It would probably be best for you to be seen by your plastic surgeon again to rule out abnormal fluid accumulation (seroma).

	Generally speaking,  tummy tuck surgery involves the interruption of arterial inflow as well as venous/lymphatic outflow. As patients' activity level increases  the abdominal wall flap may have a hard time eliminating fluids from the area. It may take several months to a year for the situation to improve  whereby patients no longer have the increased swelling with increased activity.

	I have seen some significant tissue swelling that may be alarming but has always resolved with time.

	I hope this helps.

David L. Abramson, MD · Answer

There can be persistent swelling or a Seroma. If an aspiration was tried then it is more likely swelling, particularly if that area had some liposuction performed. Be patient and wear your compression garment.

Steven Turkeltaub, MD · Answer

Has your abdomen become more protruding over the last 1 - 2 months? Do you feel firmness or a waterbed type of effect when you press on your abdomen (try laying down for this)? If your abdomen was much flatter initially after surgery, it is not unlikely that you could have formed a seroma. Just because your doctor could not aspirate any fluid out of your abdomen does not mean that there is no fluid present.

	I would suggest that you return to him for a recheck. You also may want to consider obtaining a second opinion of your situation. Though rarely necessary, an ultrasound can determine whether or not you have a seroma present.

Gordon Lewis, MD · Answer

Sorry you are unhappy at this point.  You are 15 weeks out from your tummy tuck, so most of your swelling has gone.  It is possibel that a seroma is present, but a photograph is not a good way to assess for that.  I would give it a couple more months (at 6 months, he should not argue it is swelling), then if there is no improvement, speak with your surgeon about either assessing for seroma with an ultrasound or a revision of the surgery.  He should not charge you for a revision.

	I hope it works out for you.  Good luck.

Robert K. Sigal, MD · Answer

At 15 weeks, you've pretty much got what you're going to get. A swelling, especially after removing fluid a month before, is likely to be a seroma. One way to tell is to press on one side of the swelling and look for a "water-bed" effect (or a "fluid wave") on the other side of the swelling. Go see your doc and tell him your concerns. He should be able to tell pretty quickly what's going on.

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