Tummy Tuck Seroma? Fluid Won't Drain.

3 weeks post FTT. Drains removed one week ago and swelling worsened. Yesterday, I noticed when I push on a large lump in my pubic area, I can see the fluid displace and come up in my lower left abdomen. I can see the "waterbed effect" when I lie down and push on parts of my lower abd. and the hard spot in my pubic area disappears and is flat again. PS tried aspiration (placed syringe in lower left abdomen) but nothing would come out. Could it be something else? What can I do?

Doctor Answers 12

Sometimes a longer needle is needed to aspirate the seroma

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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.
Best wishes,
Pablo Prichard, MD

Phoenix Plastic Surgeon
4.9 out of 5 stars 42 reviews

Seroma after Abdominoplasty

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What you are describing is consistent with seroma.  IF it's significant then it should be aspirated on an almost daily basis as the volumes increase.  If it is a significant seroma then there is a device on the market called a seroma-cath.  It is similar to just putting a drain back in but it's much smaller than a typical drain as the fluid of a seroma is very thin- almost watery.  The catheter is similar to a long IV catheter with multiple hoiles and it is inserted simply with a needlestick.  Your doctor should know about this product.  I hope this helps.

Scott E. Newman, MD, FACS
New York Plastic Surgeon
4.9 out of 5 stars 42 reviews

Seromas Should Be Addressed-- Contact Your PS

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It’s not unusual for patients to develop seromas following abdominoplasty.The problem may occur for a variety of reasons in the post-operative period.In some cases, the drains may have been removed prematurely, while in other cases, patient activity levels are just too high.Regardless of the cause, clinically significant seromas should be treated as soon as possible to avoid additional complications.Failure to address this problem can result in the formation of chronic seromas, infection, drainage, wound break down and a less than optimal result.
When this situation arises, treatment usually consists of serial aspirations and the use of compression garments.At this point the abdomen is still numb and can be easily aspirated.This usually addresses the problem, but occasionally more aggressive treatment is necessary.
In cases where aspiration has been unsuccessful, drainage with ultrasonic guidance may be appropriate.Under these circumstances it may be appropriate to leave a drain in place. In other cases failed aspiration may indicate that the seroma isn’t clinically significant.
It’s safe to say that the vast majority of seromas are successfully treated with conservative management.For this reason, it’s important to maintain close contact with your plastic surgeon.

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Try again

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If your surgeon tried to drain your seroma with a syringe and it didn’t decrease in size, then you can either try again or you may require surgery to remove it.

Seroma (fluid) after tummy tuck

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Historically, seromas have been the most common post operative complication of abdominoplastys. They generally respond to serial aspirations which, if the accumulation is substantial as it appears in your case, is not overly difficult to perform succesfully. It generally takes several aspirations and will require diminished activities along with compression. Other options involve placement of a seroma catheter - which is in essence replacing your drain to allow a continuous removal of the fluid.

It is imperative that the seroma is treated, since a chronic seroma cavity can significantly alter your post operative result with firmness and fullness above the surgical incision (which would require re-operation to remove the cavity). Certainly if your plastic surgeon cannot find the cavity, a radiologist can place the catheter with ultra sonic guidance. Many plastic surgeons have altered their technique over the past several years to leave more deep tissue on the abdominal fascia and not skeletonize it as was the technique in the past. Leaving that tissue allows for better re-absorption of fluid and, in my practice, has made what was once a common post-operative occurrence, a thing of the past.

Regardless, first things first - contact your surgeon and have that fluid removed asap.

Tummy tuck seroma; aspiration attempt failed. What to do now?

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What needs to happen immediately (so this seroma cavity does not become permanent) is another attempt at aspiration. After over two decades of doing tummy tucks, I have had my fair share of seromas (and even a few after drains have been removed), but I have only failed to successfully aspirate 1 or 2 patients with extremely small seromas, or extremely thick subcutaneous fatty layers. Seromas large enough to have a visible fluid wave are able to be aspirated in virtually all patients, though in patients who have a very thick fat layer that a "normal" length needle would not reach through, I use a longer IV needle, or even spinal needle.

Surgical placement of a new drain (under local anesthesia) is pretty easy if needed, though the cost of doing this in the hospital or outpatient surgical center may be prohibitive if your surgeon does not have his own surgical facility.

"Letting this go" and not draining the seroma may cause you to develop a pseudobursa that requires general anesthesia to surgically remove. To prevent the need for this, see your surgeon again, promptly!

Richard H. Tholen, MD, FACS
Minneapolis Plastic Surgeon
4.9 out of 5 stars 263 reviews

Seroma after Tummy Tuck / Abdominoplasty

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Yes, it sounds like you have a persistent seroma or fluid collection under your skin.  In most cases, the fluid can be drained by your plastic surgeon in the office by numbing the skin and then draining the fluid with a needle.  However, sometimes it requires a radiologist to drain the fluid.  In this procedure, the radiologist uses an ultrasound to look through the skin and see where the fluid collection is located.  The radiologist can then place a drain directly into the fluid collection.  It sounds like this is what you need to have done.


Good Luck.

Seroma aspiration after tummy tuck is common

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it is common to experience a seroma after a tummy tuck. often if your plastic surgeon can't aspriate from one area he can try aspirating from another area. also it is very important to keep your activity level to a minimum and wear a tight binder to keep pressure over this area.

best wishes,

sean younai, MD

Sean Younai, MD, FACS
Beverly Hills Plastic Surgeon
4.4 out of 5 stars 51 reviews

Seroma after Tummy Tuck

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Hello The Babycakes,

I am sorry you are having this very common but frustrating problem known as a seroma.  I understand that your PS tried to aspirate it but was unsuccessful, however that doesn't mean that there isn't fluid there.  It is important to remove the fluid, so please return to your doctor for a second attempt.  If unsuccessful, you will need an ultrasound to find the fluid and perhaps have it drained at that time.  I am sure that this problem will be fixed and you should go on to have a normal healing process after this seroma is treated.

Best of luck!

Gerald Minniti, MD, FACS
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 100 reviews

Seroma in abdomen 1 week after drain removal

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What you are describing is typical for a seroma of the abdomen. There clearly is a significant amount of fluid present that should be able to be aspirated. If allowed to continue untreated, not only will the deformity become larger and more symptomatic, but this could develop into a chronic problem with a persistent enclosed and lined seroma cavity. This would then require surgery to treat.

I recommend that you re-contact your plastic surgeon and have him/her make another attempt at aspiration of this seroma. You may require several aspirations and possibly even re-insertion of a drain tube.

Steven Turkeltaub, MD
Scottsdale Plastic Surgeon
4.7 out of 5 stars 33 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.