What Can I Do About the Fluid After Tummy Tuck?

Dear Tacobell,

As we all know, our bodies react to injury by swelling. Surgery is a sterile, organized short term injury to the body in exchange for improvements later on. After an injury, our vessels become leaky and fluid seeps out. Normally, as the original inflammation subsides, the vessels become normal, the leakiness stops and our lymphatics carry such fluid away resulting in tissue softening.

All surgeons have preferences how to drain abdominoplasties and for how long. Some of us are "absolutists" - they either "never" drain or "always remove the drains on post operative day X", while other plastic surgeons are "relativists" - they reserve drains for procedures associated with a lot of fluid creation AND remove such drains when fluid formation falls below THEIR accepted minimally accepted drainage amount. (I happen to fall in the latter group).

In MY opinion, as long as fluid keeps forming in amounts that are superior to the body's ability to take it away, swelling and seromas will form. After being tapped 3-5 times, I think placement of a temporary drain that efficiently removes such fluid is the way to go -- since it keeps the fluid cavity unsder the skin collapsed and more apt to heal while minimizing the hassles of repeated trips to your surgeon's office for fluid tappings.

The known downsides of a persistent fluid collection is formation of a CHRONIC bursa which MAY require a formal operation to correct it and / or infection of the fluid collection.

As regards the hardness of the suture line, unless it is associated with redness or drainage I would not worry about it. It should begin to soften in a few months.

I hope this was helpful.

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

For recurrent sermomas (fluid collections) it may be necessary to have a small drain placed rather than have repeated aspirations performed. This can be done under ultrasound guidance if necessary or if clinically apparent, in the office under local. I also recommend wearing a compression garment until the fluid subsides. If the hardness that you are experiencing is in your suture line, this may represent some fat necrosis and may have to be removed later under local (very minor procedure). if it is hardened scar tissue, then time will usually soften this up.