How do I remove a hypoechoic mass that appeared after a tummy tuck? (photo)

Question

Hi I have a hard bulge in my upper abdomen after a tummy tuck that will not go away. The picture is 12 weeks post op. My surgeon thought it was fat pushing through but after losing some weight the bulge was more prominent. I had an ultrasound and it shows a 5 cm x 5 cm hypoechoic mass in that area. How can this be addressed without a huge incision? Thanks

Robert M. Lowen, MD · Answer

This is most likely a seroma which may have developed into a bursa by now.  The walls may be thickened. Generally this would be investigated with needle aspiration for fluid with ultrasound guidance if necessary.  A CT would then be helpful to see if it is multi-loculated and if it will even respond to aspiration.  If not it has to be removed. Best way is to just open up the abdomen using the abdominoplasty scar, remove the bursa, and re-attach the skin using quilting and progressive tension  sutures this time.  That will  remove the space where the seroma/bursa forms and should take care of the problem.  In my practice I close off the dead space during the tummy tuck, so there is no space  to form a seroma, and drains are not needed. Unfortunately, even with the use of drains, seromas are not avoided.

Daniel Barrett, MD · Answer

Dear kappeler,I understand your concern. However, without a proper assessment it would be difficult to determine what is wrong. It is best that you visit your plastic surgeon for further assessment. Only after thorough examination you can get proper recommendations and advice.Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Aldo Guerra, MD · Answer

Thanks for your question. The ultrasound appears to show a seroma. At this point, the seroma is likely well formed. However, before attempting surgery, I believe it is reasonable to address the fluid by drainage and the injection of a sclerosing agent into the empty sack. Sclerosing agents can lead to the space closing down through scar formation, but this treatment does not always work and surgery is still necessary. I don't believe you always have to have the midline incision, but you need to discuss the approach with your plastic surgeon. Good luck. Dr. ALDO

Kenneth Hughes, MD · Answer

Since there are many different possibilities with different outcomes, it is important that you follow this up with your PS. I suggest that you schedule an appointment with the PS that ordered the ultrasound. He or she will be able to discuss the different possibilities this mass could be in the context of you past medical history and current physical exam. Kenneth Hughes, MD, Board Certified Plastic SurgeonLos Angeles, CA

Maximilian Malotky, MD · Answer

Thanks for your question kappeler. I'm sorry this happened to you. I agree with the other plastic surgeons that this is likely a chronic seroma. The body makes fluid in response to surgery and continues to do so until healing takes place. In tummy tucks, there is a large area of undermined skin so there is a large surface where fluid can be generated. Most of us use quilting sutures at the time of surgery and drains and compression garments after surgery to help reduce the risk of developing a chronic seroma, but unfortunately that risk is still > 0%. In the early post op period, these can be treated with aspiration, compression, and occasionally drain replacement. Once a seroma has been present for 3 months, a "bursa" or scar sac forms around it and these techniques are less effective. I would recommend f/u with your plastic surgeon to discuss if they would remove the entire bursa through your existing lower abdominal incision.

Best wishes,
Dr. Max

Best wishes,
Dr. Max

Robert Brueck, MD · Answer

the easiest thing to0 do would be for your plastic surgeon to aspirate it and that should take care of it.

James McMahan, MD (retired) · Answer

Thank you for your question and photograph.  A hypoechoic mass on ultrasound after a tummy tuck equates to a seroma.  You are thin enough that your surgeon should be able to aspirate it in the office.  It may take several aspirations to resolve, but it should gradually go away.  Rarely a drain would need to be inserted or use of sclerosing agents to make it stop recurring. Good luck.

How do I remove a hypoechoic mass that appeared after a tummy tuck? (photo)

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