Seroma for 3 Weeks - Should a Drain Be Reinserted?

Question

I've had a seroma for 3 weeks and counting post-tummy tuck. PS does not want to reinsert drains. Each time he aspirates around 20-25 cc and he is doing this daily except on the weekends. Should I ask him to put in the drains? Each time he aspirates it hurts EXTREMELY bad even with the lidocaine and I don't know how much more I can take. I sleep with a 5lb bag of sugar on my tummy as recommended by my PS.

Otto Joseph Placik, MD · Answer

Drains do not always prevent or satisfactorily treat seromas. I, like your surgeon, prefer repeated aspirations.

Remus Repta, MD · Answer

Hello,

	Thank you for the question.  I think a drain would be a good idea if you a persistently collecting seroma fluid at 3 weeks past your tummy tuck procedure.  It may be that you will require a revision to find out and eliminate the source of your seroma.  Continued seroma aspirations at 3 weeks out is somewhat rare and leads me to that suspicion.  If the amount of fluid is decreasing then this may not be the case and either continued draining or a drain along with diligent abdominal binder use may be the solution.

	All the best,

	Dr Remus Repta

Peter A. Aldea, MD · Answer

Fluid Collection (seroma) after a Tummy Tuck is not a rare event and all experienced Plastic surgeons have dealt with them. I am sure that you will get a lot of slightly different advice on how to best manage them.

	The conditions of the walls around a fluid collection dictate the ease with which it will go away. If the walls are raw, as seem with a freshly operated wound, as long as the fluid is not allowed to accumulate, the walls are touching each other and more apt to stick together obliterating the cavity. There is no doubt that a drain (draining constantly results is a more collapsed cavity and greater wall contact time than a seroma whose contents are removed with a syringe every other day or so, but the discomfort is greater with a drain).  After the seroma existed for a few weeks, its walls become covered with a increasingly thicker layer of smooth epithelial lining which is NOT as apt to stick together; such chronic seromas may become a BURSA. Bursas are very hard to eradicate non-surgically and may require a re-operation in which the lining is removed and a drain is placed.

	I would advise you to wear some kind of compression garment (even spanx) around the clock (instead of the 5 pound bag) and decide with your surgeon when to change treatments if the seroma persists. If it persists, you may wish to have a drain placed as a radiology out patient where is will be placed under ultrasound control. Prolonged drainage from the drain can be then tackled by the injection of an irritating antibiotic into the seroma cavity to get the walls inflamed enough to stick together. Finally, if this does not work, then you may need to have an operation. As a measure of perspective, in the hundreds of Tummy Tucks I have performed, I never had to go this far to resolve a seroma and I doubt you will need to.

	Good Luck.

	Dr. Aldea

Kamran Khoobehi, MD · Answer

This is a common problem after tummy tuck and your surgeon has tried the aspiration. I would suggest the drain since the aspiration is not getting less. The other treatment is wearing tight girdle and using lasix.

George J. Beraka, MD (retired) · Answer

Hi.

	Sooner or later you will get an infection or a chronic seroma cavity.  Every surgeon does things a little differently, but after  tummy tuck in New York City, we send a patient like you to an interventional radiologist, who inserts a seroma drain under ultrasound guidance.  Very safe.

Seroma for 3 Weeks - Should a Drain Be Reinserted?

Answers (5)

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