Nothing is coming out of my seroma after multiple attempts to aspirate the area, could problems if left untreated?

Question

I am 7 wks post-op from a mommy makeover. I have a seroma below my TT scar that my surgeon & his nurse have tried to aspirate on 5 occasions over the last 4 wks. They are unable to get anything out. They seem baffled by it, but keep reassuring me that my body will take care of it on its own. I don’t feel comfortable continuing to wait for this to be resolved. I’ve read this can cause issues if untreated. Also, it is creating new stretch marks, which ticks me off. Should I be worried?

Robert L. Steely, MD, FACS · Answer

Good eveningSometimes after an abdominoplasty you can have postoperative collections of fluid or blood.  Fluid should aspirate pretty easily- blood can be difficult to aspirate early in the postoperative period because it will clot.  after 10 days or so it will reliquify making it easier to aspirate.While still possible that you have blood or fluid there, there could be some retained fat causing you deformity.  It could also be loose corset sutures that have allowed the lower part of your abdomen to protrude giving a contour deformity. If it continues to persist a CT scan would help, or surgical exploration of the area in question could be both diagnostic and therapeutic.I hope this helps

James H. Rogers, MD · Answer

Seromas are one of the most common complications associated with abdominoplasty(tummy tuck). Most readily resolve with repeated aspirations, and rarely is revisional surgery required or the outcome adversely affected. If repeated aspirations have been unsucessful, it must be considered that the problem may not be a seroma. If a hematoma, or bloodclot formed after surgery, it may be too solid to aspirate. Occasionally , a bloodclot or seroma can form under the covering of the muscle(rectus sheath) and is not removed with normal aspiration. Fat necrosis can occur , forming a swollen firm area . A simple test called an ultrasound of the abdominal wall can be done to readily identify if the area in question is solid or fluid. Ask,your surgeon if this would be of benefit in your case.

Ryan Hoffman, MD · Answer

A seroma is a collection of fluid that can be aspirated or drained. Swelling is fluid in the tissues that can't be drained. It is difficult to tell by your story which of these you have. The one definitive way to find out is to get an Ultrasound. Check in with your doctor or see a second opinion if you are still concerned.

Ashley B. Robey, MD · Answer

Hi, I am curious as to how the diagnosis of a seroma came about. It would be unusual to have a large and visibly palpable seroma that could not be aspirated. Sometimes, patients can have a significant degree of swelling that could be misconstrued as a fluid collection but is actually just edema within the layer of tissue itself. If your surgeon has attempted aspiration many times but gets nothing, perhaps she/he thinks it's just swelling and not a seroma. Tiny seromas would likely resorb, but if you still have one at 7 weeks, that is more of a subacute seroma. Chronic seromas are less likely to resolve on their own and often need procedural intervention. Wear a snug compression garment; if you can easily pull the garment up off of your abdomen, it is probably too big/loose.

Camille Cash, MD · Answer

It may be that an ultrasound is needed to determine if the area in question is perhaps not a seroma.  It could be swelling, which would explain the inability to aspirate it.  It could potentially be a hematoma as well.  An ultrasound should reveal more information.

Bruce K. Smith, MD · Answer

At 7 weeks, it can be difficult to tell the difference from  fluid that is outside the tissues (seroma) and swelling within the tissues, especially if liposuction was performed. The body will absorb and heal fluid collections and in the process a large space may be divided into smaller spaces of fluid that are difficult to access with a needle. Sometimes ultrasound is required to locate the fluid collection. If your are anxious about the issue, I would invite you to seek a second opinion in regard to treatment options. Please select a plastic surgeon board certified by the American Board of Plastic Surgery and preferably a ASAPS member, (American Society of Aesthetic Plastic Surgeons).

Matt Erdmann, MBChB, FRCS(Eng), FRCS (Plast) · Answer

I would suggest that a simple ultrasound (US) be carried out which can differentiate between a fluid collection (which can be aspirated) or haematoma (which cannot).
The most usual cause is a haematoma which usually liquefies with time and can be left alone or aspirated. Or It may remain as a hard lump which will eventually be absorbed by the body. It can also form several smaller collections which need aspiration individually under US.
Either way you should be reassured by the results of the US

Robert E. Zaworski, MD (retired) · Answer

At 7 weeks post op it is unusual to have a seroma.  Consider posting photos so we can better answer your question.  Based on the information you have shared, I would wear my compression garment as much as possible and continue follow up visits with my surgeon.  Hopefully, you are on the mend.

Nothing is coming out of my seroma after multiple attempts to aspirate the area, could problems if left untreated?

Answers (8)

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