Seroma or Swelling at 8 Weeks Post Op? (photo)

Question

I am 8 weeks PO but have been wearing the binder for the past 6 weeks. I have started light cardio for 20 mins for the past 4 days.I look as if I am 3-4 months pregnant. My stomach feels numb, hard, and sometimes hurts. I am not sure if this is a seroma or just swelling that needs to go down more.Sometmes the swelling goes down a bit but then comes up again. Saw my PS a week ago and he says I don't have seroma, but I am still unsure.I tried to feel for a waterbed wave but only hardness. Help.

Remus Repta, MD · Answer

Hello,

	Thank you for the question and photos.  I suspect you may have a seroma.  The "water bed wave" tends to go away when the seroma gets too full.  Sticking a large caliber needle  through your incision area just above the pubic bone would be a diagnostic and potentially therapeutic maneuver.  I would have your plastic surgeon do that for peace of mind.

	All the best,

	Dr Remus Repta

Jourdan Gottlieb, MD · Answer

From the photos and the story, I would be most suspicious of seroma, and would ask to be seen again by your surgeon. This does not appear to me to be typical of post-op swelling.

	Thanks, best wishes.

Darryl J. Blinski, MD · Answer

Based ONLY upon the posted photos and limited explanation SEEK immediate evaluation from your surgeon or seek urgent care. appears as a large distention or seroma/hematoma. PLEADE seek care.

Tom J. Pousti, MD · Answer

Thank you for the question and pictures.

	It is best to be seen in person ( by your plastic surgeon) for precise diagnosis and treatment. Since you were seen last week, you may want to request a follow-up with him again this week.

	 Generally speaking, abdominal wall "swelling" after tummy tuck may be related to:

	1. Swelling in the soft tissues.  This may take several months to resolve and may worsen with increased activity  or at the end of the day.   Patience  is required to allow for resolution of the swelling. The swelling occurs because of the interruption of venous and lymphatic channels that occurs during the tummy tuck operation.

	2. Fluid accumulation in the space between the skin and the abdominal wall muscle.  this may consist of blood ( hematoma)  or serum (seroma).  This fluid accumulation can generally be diagnosed by physical examination ( occasionally ultrasound  may be helpful).  Treatment consists of aspiration;  several episodes of aspiration may be necessary. 

	3. Separation of the abdominal wall muscle repair may lead to a swelling/bulge appearance. This may be diagnosed on physical examination  with your surgeon examining you in different bodily positions. One of the steps of a tummy tuck procedure involves reapproximation (plication)  of the rectus muscles.  These muscles have spread apart during pregnancy and/or weight gain. Bringing them together again in the midline helps to “tighten” the abdominal wall as well as to narrow the waistline.

	4. Residual adipose tissue may be confused for swelling. Again this is most easily diagnosed by physical examination. Additional liposuction surgery maybe necessary to improve the results of surgery.
	Generally, it takes many months for swelling to resolve after tummy tuck surgery and it may take up to one year  (or greater)  a complete skin redraping  to occur.

	I hope this helps.

Richard P. Rand, MD, FACS (retired) · Answer

Your photos look quite distended - did you look like that when your PS saw you or is this different now? We also don't have a preop to know your starting point. Best to re-visit your doctor for another exam.

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