Is It Possible to Suture a Persistent Seroma or Does the Capsule Need to Be Removed?
Doctor Answers 4
Persistent Seroma Treatment
The following options exists:
1. Repeat closed suction drainage
2. Chemical scarring of the capsule/bursa (sclerosis)
3. Surgical removal of the capsule/bursa and closed suction drainage
Regarding : "Is it possible to suture a persistent seroma or does the capsule need to be removed? "
Your question is frustratingly general and therefore impossible to answer without assumptions.
Seromas are fluid producing areas that may occur after surgery when the fluid producing capacity exceeds the body's and any present drains ability to remove it. If the seroma is fresh (ACUTE) it can be managed with serial, frequent needle aspirations and often resolves. If the volume is high, a drain may be needed to aid in constant fluid removal. If it persists, instead of the fluid cavity having a raw lining which WILL adhere and close the cavity, the lining becomes smooth transforming it into a CHRONIC seroma or BURSA. These may be attempted to resolve by placing an irritating antibiotic solution in it to inflame the walls. But in most cases, the bursa needs to be opened, smooth wall removed and it needs to be closed over drains. Putting stitches through the walls without getting the smooth lining off will not work.
Treatment of seroma in breast augmentation
A seroma is a fluid collection that occurs after surgery, typically when a space or cavity has been created during a procedure. In plastic surgery, it most commonly occurs in tummy tucks, but may occur with breast implants, as well. Seromas can be problematic if not treated because the fluid does not resorb (or resorbs very slowly), leading to a distorted (swollen) appearance, sensation of heaviness, and possible puckered appearance when the seroma finally does resolve. Treatment is aimed at removing the fluid and closing down the space so that the seroma cavity walls can seal itself from the inside.
A seroma is generally treated by (progressively more invasive):
- removing the fluid by serial aspiration (sucking it out with a needle every day or couple of days)
- removing the fluid by placing a drainage tube and allowing it to drain out for a period of time
- injecting irritants (eg some types of antibiotics) that will make the cavity walls 'sticky' so that they heal together
- sewing the seroma cavity together onto itself
- cutting out all or part of the seroma cavity
- a combination of the above
With the presence of a breast implant, some options are not practical. For example aspiration could lead to damaging the implant. If a patient has a breast implant with an accompanying seroma, one possible treatment would be to place the implant in a different plane (either sub pectoral, neo subpectoral, or subglandular) and remove or sew down the seroma cavity. This assumes that the implant is to stay in. Treatment may vary greatly depending on the clinical situation.
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