How to Get Rid of Seroma After Tummy Tuck?

Question

I had a Tummy Tuck done 4 weeks ago. I feel that I still have accumulated liquid in my lower abdomen. How do I get it out?

Ronald J. Edelson, MD · Answer

Fluid accumulation after a tummy tuck can be frustrating for both patient and surgeon.  Most surgeons will draw off the fluid with a needle in the hope that the amount of fluid gradually goes away.  If a seroma is still present after a few aspirations and the volume is more than around 50 cc’s, I will place a special  kind of drain in the cavity which solves the problem easily and predictably.  It is called a penrose drain and is inserted through the incision under local anesthesia.  This is a different kind of drain than the one you had after surgery. It allows to fluid to drain to the outside and the cavity to gradually close.  I usually remove the drain in a week.  This technique takes advantage of the well known principle of “dependent drainage”.  This will solve the problem once and for all.  The truly surprising thing is that most plastic surgeons aren’t familiar with this tried and true method even though it has been around for a long time. Good luck!

J. Timothy Katzen, MD, FACS · Answer

Hello, and thank you for your question about how to get rid of fluid accumulation in your lower abdomen following a tummy tuck. At just 4 weeks post-op, what you’re describing could very well be a seroma, which is a pocket of clear fluid that collects under the skin after surgery — particularly common after procedures like tummy tucks where large areas of tissue are lifted.

If you feel a soft, squishy, or sometimes firm area that moves when pressed, or you notice a bulge that hasn’t gone away, it’s important to have your surgeon evaluate it. Some seromas resolve on their own if they are small, but others need to be drained with a syringe and needle in a sterile environment — a procedure called aspiration. This is a quick, in-office procedure and often provides immediate relief.

Do not attempt to drain it yourself, as this can cause infection or injury. The fluid is sterile until it’s exposed to bacteria, and introducing anything unclean could lead to a serious complication.

If left untreated, a seroma may:

Harden and form a pseudocapsule (scar tissue pocket)

Cause prolonged swelling or discomfort

Become infected, turning into an abscess

Your surgeon might also recommend continued compression garment use, lymphatic massage, or drain placement if fluid continues to accumulate. Sometimes, if a seroma becomes chronic or fibrous, surgical revision may be necessary — but that’s usually a last resort.

You’re doing the right thing by paying attention to your body. Please contact your plastic surgeon right away so they can assess whether you need drainage and ensure your recovery continues smoothly.

Wishing you a safe and comfortable resolution ahead.

Sincerely,
Dr. J. Timothy Katzen, MD, MBA, FASMBS, FICS
(Certified by the American Board of Plastic Surgery and President of the American Society of Bariatric Plastic Surgeons; Fellow of the International Society of Aesthetic Plastic Surgery, American College of Surgery, International College of Surgery, and American Board of Metabolic and Bariatric Surgery; Member of the American Society of Plastic Surgeons, American Academy of Cosmetic Surgery, and RealSelf Hall of Fame)

Prompt attention to a possible seroma can prevent complications and help you get back on track with your recovery — don’t wait to be seen.

S. Larry Schlesinger, MD, FACS · Answer

A seroma is a collection of injury fluid seen in many parts of the body after almost any surgery.  Unfortunately, it is quite common in the lower abdomen after a tummy tuck.  Usually, this is due to inadequate lymphatic drainage.  Seromas after a tummy tuck fall into 3 major categories.  The first and most benign is a seroma, when drained by your surgeon, never reoccurs.  The second type of seroma recurs multiple times after drainage, and may require installation of a sclerosing agent.  The third type of seroma is a chronic situation requiring re-exploration of the abdomen and removal of the seroma capsule.  I recommend you call your plastic surgeon as soon as possible because the longer the seroma remains undrained, the greater chance you have of forming a pocket which needs surgical excision.

Pablo Prichard, MD · Answer

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.Best wishes,Pablo Prichard, MD

Tom J. Pousti, MD · Answer

Have your plastic surgeon aspirate the collected fluid to avoid any other complications. This can easily be done in the office using a needle and syringe. It is normal to develop some fluid build-up after this type of invasive surgery.

Edmond A. Zingaro, MD · Answer

You need to return to your plastic surgeon. If there is a significant amount of fluid it will have to aspirated. This may have to be done more than once so you should be ready to return several times. If the fluid just keeps accumulating, a drain may have to be put in.

Jack Gelman, MD (retired) · Answer

Return to see your plastic surgeon. The fluid can easily be aspirated in the offfice.  However, if you continue to delay the body can wall off the fluid and it will be difficult to remove.

How to Get Rid of Seroma After Tummy Tuck?

Answers (7)

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