Calcified seroma 9 months post op? Area is getting more firm and tight. Recommended that I have surgery either way? (photos)

Hello @Lily2013, thank you for your question. Any kind of abnormality about the process must be analyzed, because there is no way to have a treatment if you are not clear about what is going on. The first step may be to do an ultrasound of the area. The best course of action is to consult one or several board certified plastic surgeon for more information and options tailored specifically to your needs. Best wishes! Alan Gonzalez MD FACS

Thank you for your question regarding what to do with a calcified seroma and whether it’s advisable to leave a seroma capsule alone. If your calcified seroma capsule is not causing you problems like pain, discomfort, visual deformity, or fluid accumulation, I will leave it alone. However, if the calcified seroma starts to act up in any way, you may require further workup to include an MRI, serial aspirations, and potential surgical removal. However, at this point, I would not suggest removing the asymptomatic, calcified seroma capsule after a tummy tuck (abdominoplasty). 

I’ve seen this occur several times and there’s a simple way to deal with it. Not all surgeons do this even though it’s been around for only a few hundred years. Your incision needs to be opened about a half inch in the midline. Then a penrose drain needs to be slid into the cavity to provide external drainage. It will drain to the outside and be a little messy. Leave it in for a week. I’ve done this many times and it never fails. It’s based on an old principle called dependent drainage. Dependent drainage is a very old basic surgical principle. Google the term. Remember PENROSE drain, not any other kind will work.

Dear Lily2013,
I understand your concern. However, without a proper assessment, it would be difficult to determine what went wrong. It is best that you visit your plastic surgeon for further assessment or ask for a second opinion. Only after a thorough examination, you can get proper recommendations and advice.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

If the seroma cavity has calcified, it will need to be removed surgically and rains left. You should go to a plastic surgeon for this. This is a strong case for having your surgery in the area where you live so you have good follow up care.

It is not unusual for a seroma to be drained multiple times before resolution. If it persists your surgeon may place a drain to help the area heal. As a last effort your surgeon may surgically address the area. I encourage you to work with your surgeon to find the appropriate solution for you. If you do not want to travel to your surgeon you will need to find another in your area to assist.

Your photos and postop history are concerning. What does your chosen surgeon say or want to do? Have you had ultrasound examinations ? Has the Seroma grown in size/volume? Usually multiple aspirations are followed By placement of long term in dwelling catheter/drain. And final option is surgical excision. Best to virtual consult with…

I do not recommend patients travel long distances for elective surgical procedures especially not something as major as a tummy tuck.
The correct treatment of a seroma is to have it aspirated on a daily basis as soon as it appears.Failure to keep this aroma pocket continuously drained will lead to a chronic seroma that’s encapsulated.
Once encapsulated there’s no option that will work except a complete excision of the arooma capsule with placement of a drain.
Injecting sclerosing agents and drain placement are unlikely to resolve your situation.
There’s a window of opportunity to treat these nonsurgically if treated aggressively immediately upon detection which is usually a few days after the drains come out.
If not managed properly at that time once encapsulated. Full excision with placement of a drain is the only thing that will work.
This should ideally be done by a plastic surgeon.
Any board-certified plastic surgeon should know how to manage a seroma.
Best,
Mats Hagstrom MD

Hi and welcome to our forum!
I'm sorry to hear of your difficulties following your abdominoplasty. A seroma is a collection of tissue fluid accumulating at the operative site. It is caused by injury to the soft tissues. When blood vessels and lymphatics get damaged through the normal course of the operative procedure, the body mounts an inflammatory response, resulting in the production of clear fluid. Normally, the body absorbs this fluid, but, if excessive, it will accumulate and create a seroma.
Small seromas will naturally resorb, but larger seromas require drainage. Serial needle aspirations may be required. If repeated aspirations fail to control the seroma, a drain is placed and is usually left in place until the drainage subsides. If the seroma persists for more than several months, sclerosing solutions (we employ doxycycline) can be introduced through the drain to create scar which will retard fluid accumulation.
However, as your seroma has calcified, surgical excision of the tissue making up the walls of the seroma appears to be necessary. Closing the resulting defect with a quilt like technique appears to be of benefit.
Continue follow-up with a board certified plastic surgeon.
Best wishes...