Bloody Seroma Caused by an Aspiration Mistake?

I am 5 weeks post-op from a tummy tuck. After week 2 I began to get a waterbed wave of fluid across my abs above my incision. The PS removed the fluid that was a pinkish/red color. During the aspiration, I felt the needle poke me inside, the PS apologized.

On my 2nd visit a week later, the fluid was a dark, deeper red and also on the 3rd visit. The fluid level is just about the same each time. The PS is now concerned about the color of the fluid.

Is it possible that he hit something when he did the 1st aspiration? He wants me to get blood work and possible surgery at my expense.

Doctor Answers 4

On aspiration, bleed can certainly cause a seroma to be more 'bloody'

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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. I have never seen an infection from sterile aspiration of fluid. If seromas continue despite multiple aspirations over an extended period of time, then you need to start thinking about re-openning the incision and excising the entire capsule, both from and back walls, to treat the seroma. Drains need to be placed, internal sutures placed, possibly using a tissue glue or irritant to encourage the tissues to grow together.
Best wishes,
Pablo Prichard, MD


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Seromas are quite common after tummy tuck operations, and typically they are treated by serial aspiration. The red coloration at the first aspiration is a sign that blood was there from the first. The fact that it was redder just means there is a bit more blood and less serum. If more blood was introduced it was probably from passing the aspiration needle--- it is being passed through living tissue with blood flowing, so I don't see any "mistake." 

A surgical procedure seems unlikely unless all else fails, including repeated aspiration, insertion of a drain, and an attempt at sclerosis, which is injection of a caustic material such as betadine, tetracycline or alcohol which usually causes the secretion to stop.

Thanks for your question and best wishes. 

Jourdan Gottlieb, MD
Seattle Plastic Surgeon

It's possible but probably no cause for alarm

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Seroma formation after abdominoplasy is very common. Almost always it can be sreolved by serial aspirations in the office. Sometimes this may require 5 to 10 sessions, but usually not. If the aspiration needle nicked the fascia, you might have bled a bit into the seroma, turning it burgundy. Actually only a few drops of blood can do that.

I would continue with the serial aspirations. I think your problem will resolve itself.

Seroma and Fluid Accumulation after Tummy Tuck

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Seroma and fluid accumulation is the most common issue after tummy tuck. Once the drains are out the only options are to do serial aspirations, place another drain or rarely surgery. During the aspirations there is always the risk of reaccumulation and the risk of have some bleeding from the tiny blood vessels in the area. That bleeding is usually self limited and not a reason to have surgery.

The reason to perform surgery is because after multiple aspirations and perhaps even drain placement the fluid continues to build up over and over. Again that is a rare instance, I for instance have never had to take a patient back to surgery for recurrent seroma.

As far as the cost, that is something you need to discuss with your plastic surgeon. Unfortunately there are some costs that are passed down to the patient as the procedures are not covered your health insurance.

Good luck

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