Above Tummy Tuck Incision Line. Swelling? Fluid? Sponge Like Fluid? I'm Confused.

It is possible that the fluid collection (seroma) is there even if it is difficult to aspirate with a needle.  Although it can take some time, your body will absorb this fluid and the swelling should resolve.

Sincerely,

Martin Jugenburg, MD

Thank you for the question.

Some swelling after tummy tuck surgery is to be expected and may continue for several months after surgery. It may take up to a year to see the final results of surgery. Localized swelling  (for example the “bulge” above the belly button)  may be a seroma  or hematoma. Since your surgeon has tried to aspirate the area several times it is likely that the swelling is in the soft tissues as opposed to the space between the tissues and the underlying muscle.

I would suggest continued follow-up with your surgeon as you have planned.

I hope this helps.

When I see this in my patients I refer them to the Interventional Radiologists at my main hospital (Baptist of Miami). They preform a scan with radiographic guidance needle aspiration and possible insertion of a drain. 

At only two weeks post op the most likely cause of fullness in the area you describe after tummy tuck is fluid. The other potential cause is fat. Fluid can be pooled in the space between the muscle layer and the skin and fat layer, or it can also be present within the tissues. I think this is what your surgeon refers to as a sponge effect. Swelling is simply that:  fluid distributed within the tissues. It may take several months for swelling to completely resolve, so you and your surgeon need to be patient.

Hello,

Thank you for your question.  It sounds like you have accumulated a seroma (collection of helaing fluid) just above the incision line which is the most common place for it.  If the amount of fluid is dispersed over a larger area it can be a fairly thin layer of fluid and therefore can be difficult to successfully drain the fluid with a needle since the needle must be directly into the thin layer of accumulated fluid.  Sometimes leaning forward a bit a pressing on the sides will allow the fluid to pool in the center and can make draining it easier.  You may have to do this several times and wear the abdominal binder fairly snug to get the two layers of tissue to heal together and prevent the fluid from accumulating.  

Hope this helps

All the best,

 

Dr. Repta

Phoenix/Scottsdale plastic surgery

While you are standing tap lightly on one side of your lower abdomen. 


Seroma: Fluid collection on the space between the tissue that was elevated during surgery and the muscle wall.  If you see a wave like a water bed (not a jiggle) that goes across your abdomen, you have a seroma.  They can get tricky to aspirate, but if they aren't you can develop something called a bursa which is a layer of scar tissue around the fluid that will prevent the tissue from adhering (sticking) back to the muscle layer underneath (even if the fluid is eventually absorbed).  It is just like the capsule that forms around a breast implant.  It has to be excised surgically.

Swelling: fluid within the tissues themselves.  If there is no wave then you have swelling that will absorb over several (4-6) months.  It takes longer than you would wish, but it is not a problem.


Be sure you are standing when your PS tries to aspirate the fluid (if you have any).  If he/she thinks there is fluid and he/she can't aspirate see if one of his/her associates will.  There are four of us in our office and on several occasions this has worked for us.

The difference between swelling and a seroma after a tummy tuck is that a seroma is a free fluid collection between the fat and muscle layers. Large serumas are fairly easy to drain with a needle and syringe so you likely either have a small seroma or normal post-operative swelling. Either way it should resolve on its' own but even swelling can take several months to settle down. Like many things after plastic surgery the answer is time and patience.

There are different reasons why someone may have swelling above the incision line early after a tummy tuck, one of which is fluid beneath the flap which is called a seroma. Other reasons are normal postoperative swelling, thickening beneath the incision line from the layered closure of dissolvable sutures and the healing scar tissue, lymphatic drainage that does not yet drain across the incision (less swelling in the morning after sleeping flat, more swelling during the day as you are up...this is normal and resolves over time), hematoma (firm, usually but not always accompanied by bruising). If the swelling is due to a seroma, that is what your surgeon is trying to aspirate with a needle, but it is possible that he is not hitting the cavity. If it is one big cavity, it is easier to find and aspirate. If it is broken up into many different cavities, then it is harder to do so...and that is what he is referring to as "spongelike". Generally if there is a seroma cavity filled with fluid, you will detect a "fluid wave" which acts a little like a small waterbed when you push on one part of it. An ultrasound can be used to evaluate your tummy, look for fluid collections, and even tap any significant seroma and insert a small drain in it. This may be a good alternative to another small surgery to reinsert a drain. Your surgeon may be trying to save you the expense of an ultrasound, but ultimately if he is not able to evacuate whatever is causing the swelling, this may be the next step to consider.