What is this lump after my tummy tuck?

Question

This picture is taken while laying down first thing in the morning with bladder FULL to show it at largest- No pain from it ever. It does shift from below belly button on right- some days directly below belly button and crazy enough one day on left! Mornings laying down are key time. I can not feel it standing up. Once in awhile I feel it at night. My plastic surgeon blew it off since he couldnt feel it standing up so after seeing picture said "wow- you need to have that seen" What do I do?

Otto Joseph Placik, MD · Answer

I am a little puzzled by your plastic surgeon's advice. Typically a seroma should be easily diagnosed and would be more apparent standing rather than laying down. His/her surprise may indicate that it is not a seroma. If it is associated with raising your head it may be a hernia or separated diastasis repair. Ultrasound or CT scan may help in the diagnosis.

Steven Wallach, MD · Answer

The lump could be many different things but the most common cause is a seroma. You should definitely see your surgeon.

Robert Whitfield, MD · Answer

Have you had this problem since surgery?  WHy are you 6 months out with this problem?  This is a little hard for me to understand.  Ultrasound should sort this out though!

Carmen Kavali, MD · Answer

You appear to have a seroma after your tummy tuck.  A seroma is a collection of straw-colored fluid under the skin--the fluid is what your body normally produces as part of the wound-healing process.  Sometimes more is produced in a certain area that the body can absorb, so it makes a "puddle".  Typically, this happens when the drains are removed soon after surgery, when compression isn't used faithfully, when a woman returns to increased physical activity too quickly, or in heavier women (fatty tissues make more of this fluid).  Sometimes it happens even when none of these things applies--it can just happen.

	I'm thinking this isn't a hematoma because there's no pain and no increased bruising of the skin over it, but it still could be a hematoma nonetheless.

	I doubt it's a hernia because you can only see it when you're lying down.

	A seroma is treated with serial aspiration (using a needle) or by drain placement.  Please do get back to your surgeon for evaluation and treatment.

Peter A. Aldea, MD · Answer

Regarding: "This picture is taken while laying down first thing in the morning with bladder FULL to show it at largest- No pain from it ever. It does shift from below belly button on right- some days directly below belly button and crazy enough one day on left! Mornings laying down are key time. I can not feel it standing up. Once in awhile I feel it at night. My plastic surgeon blew it off since he couldnt feel it standing up so after seeing picture said "wow- you need to have that seen" What do I do?"

	I have done several hundred Tummy Tucks and have not seen something quite like this before (time line, description, symptoms).

	It does NOT sound like a hernia (? reason why your surgeon "blew it off"). Hernias are WORSE when standing and straining. Do not sift sideways and get more painful when upright and usually get less painful and may even go away when lying down.

	Tumors VERY rarely develop so rapidly and are usually fixed and do not shift.

	It most likely is a seroma, a fluid collection.

	I would recommend you get either an Ultrasound or CT scan and have it looked at. If it is fluid, your doctor should ask the radiologist to put a needle in it and draw out the fluid at the same time.

	Good Luck.

	Dr. Peter Aldea

Claudio DeLorenzi, MD · Answer

Ultrasound is a painless investigative procedure that uses sound waves to create pictures of what is going on deep to the surface of the skin.  It is very good at differentiating fluids from other things, and it would be particularly useful in your situation.  It would help to figure out if that lump is made of fluid or whether it is made up of something else.  It should be scheduled for you first thing in the morning, soon after getting up, since the problem appears overnight. It would also be a good idea to schedule a visit to your surgeon first thing in the morning for the same reason.  If the lump appears on the downside of the side you happen to be sleeping on, it is likely to be a seroma (doc-talk for a collection of fluid similar in consistency to the fluid found under a blister or in a swollen ankle after a sprain).

	 Early on, seromas can be handled non surgically, but when they have been a problem for a while, they often need surgical management to get rid of.  

	They can be avoided altogether by seeing a surgeon that using a graduated tension technique, sometimes termed a quilting technique to close all the areas during the initial surgery.  This takes time, because the large area between the muscles of the tummy and the overlying skin flap has to be tediously closed with sutures.  This was popularized by a South American Surgeon named Ricardo Baroudi (although several other surgeons have tried to take credit for his ideas).  I have been using Baroudi's technique for over 10 years, and I have never had a seroma since then.

Kamran Khoobehi, MD · Answer

You are obvious bulge that can be due to hernia,seroma or combination. You will need physical examination and possible ultra sound or CT scan.

Verne Weisberg, MD (retired) · Answer

Its really hard to tell what's going on just from the picture. It looks like it's been some time since surgery. It could be a localized fluid collection, or a weakness in the abdominal fascia, which would be more likely if it bulged with straining and went away lying down. A CT or MRI would probably clarify the diagnosis.

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