Tummy tuck seroma won't go away?

Question

I've had a seroma since week two post tummy tuck , after several aspiration and putting the drains back in then treating it with antibiotics thru the drain. I'm still accumulating fluids once the drain have been taken out the second time. Whats the next step? Will this end without a second surgery?

Christopher J. Davidson, MD, FACS · Answer

It is a common complication to have a seroma post op.  It sounds like your PS is doing the right thing in his/her treatment.

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

Louis DeLuca, MD · Answer

Thank you for your question.  Seroma ( an accumulation of fluid) after a tummy tuck is not uncommon.  Drains are usually left in place after a tummy tuck procedure to remove the fluid until it slows down enough for the body to take over and absorb it on it's own. Sometimes a seroma will reform after the drains are removed.  Repeat drainage and replacement of drains may be necessary.  It is also important to apply some compression to the area to prevent fluid from collecting in the empty space under the skin.  The good news is that it rarely needs any more intervention.  Patience and persistence is the best plan.

Damian Marucci, MBBS, PhD, FRACS · Answer

I am sorry to hear of the problems you are having with recurrent seromasfollowing tummy tuck surgery.Seromas usually first appear in the first weeks after surgery. All patients develop fluid in their wounds in the first few days after a tummy tuck. Leaving the drains in until they have stopped draining in usually sufficient to prevent a seroma developing.Some patients develop a delayed seroma when they have had an unrecognised bleed into their wound, and the "seroma fluid" is just the haematoma breaking down into a more fluid state. Other seromas can be caused by damage to lymphatic channels, which can sometimes persist for weeks. Finally, infection can cause a reactive production of fluid (although it usually isn't clear or straw-coloured like a traditional seroma). If there is any mesh in your abdomen, infection could be a concern.The key thing is to make sure your plastic surgeon is aware of the problem and is sorting it out. If you have already had drains placed and the seroma has still come back, unfortunately, your plastic surgeon may be considering opening things up again, washing it all out and putting in some large bore drains - then leaving them in until they stop draining.Good luck with your treatment.

Brooke R. Seckel, MD, FACS (retired) · Answer

Thank you for your question.It is very important that you follow the advice and make frequent visits with the plastic surgeon who performed your tummy tuck.  It sounds as though the surgeon is managing you properly with expertise.Seromas that last a long time, certainly over 6 weeks or more in some cases will form a membrane around the seroma called a seroma cavity.  In some cases if the seroma cavity is palpable or creates a bump a minor second surgical procedure can be done to remove the cavity.However you must be patient and hopefully you will not need this.

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