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Michael Chiaramonte, MD
Board Certified Plastic Surgeon
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Congratulations...It's a Seroma!

I am post-op week 4. Seroma: As you know my right drain was removed last Friday (2/26), despite in being in for 3 weeks and still draining over 50 cc’s clear (serous) drainage. Dr. C told me to come back on the following Wednesday. I knew I would be a good candidate for a seroma given the above and I was okay that-as everything has been going well thus far, thank GOD! So, I noticed particularly since Monday that I have had increased swelling above my entire incision. Monday was my first time doing housework (mopping, cleaning, laundry, cleaning the puppy’s crate, etc.) I did a lot of work. I felt good, no pain, exhaustion, or anything. My initial thoughts were that the swelling was related to increased activity, which may have been a contributor. But I researched RS about Seroma and I self-diagnosed myself. The last two days I have been changing positions to see if the fluid shifts and tapping my belly like a keyboard and watching the waves. Its very interesting to see and feel. I felt pressure in my lower abdomen and some heaviness. No pain at all, but like I was a little pregnant (meaning the early fullness when you start to show). I tried to increase the pressure by applying extra compression with and tighter abdominal waist workout trimmer I had that I could tighten more than my abdominal binder, but despite those efforts, it helped very little. I didn’t call the office, I knew what it was and felt okay and calm…not an emergency. If you are not familiar, a seroma is a collection of fluid between the skin and fat tissue or skin and muscle (I have seen it worded this way) above the incision. The area waves when you press on it and feels like a water balloon kinda. There is no pain or any other discomforts, for me. This is listed as a common complication with TT’s. However, complication is not the best word; side effect is what I would say. The word complications give a Seroma a bad rap and sounds worse than it really is. So, I go to the office and Dr. C says what’s up. I said, I think I have some fluid in there (patting on my belling). He takes a look, but before he does he is looking and I am making my TT area do the wave. He looks, presses, and said Yep, there some fluid in there. He said he figured this would happen with me given the amount of fluid that was draining, but the drain had been in too long and it could have led to an infection which would be waaayyyy more complicating. We laughed about it and I said I was totally cool with it. He stepped out to grab the nurse and they returned. I leaned back in a semi-laid back position on the exam chair. The nurse was on my right and Dr. C was on my left. I didn’t even look to see what he was preparing. I read about it and wasn’t too concerned with what was about to go down down there. I did not require any numbing medication, lol, I am still numb from the surgery. So when Dr. C was ready, he signaled the nurse, and she began pressing (there was no pain) on the left side of my TT incision where the swelling was. This was to apply opposing pressure to the area moving the fluid to the opposite- aka the side he was draining. I felt a small pressure (only way I can describe it) and he drained my seroma. This took less than 5 minutes. The entire time we were talking. I joked that I felt I was ready to give birth…the nurse asked to what laughingly, I said to a boy (since I have girls). The we all talked the number of kids we all had and dogs-Dr. C has a new puppy too and we were verbalizing our frustrations with the process, lol. So, the seroma drainage went off without a hitch-no pain, no drama, didn’t feel a thang. I asked how much fluid he drained-I calculated 275 cc, lol because I was draining at least 55 ccs-this over 5 days equalized that amount. To my surprise, he only drew 90 cc of clear fluid-having 90cc seemed like a little to me as far as the amount, but it looked like there was way more fluid based on the amount of swelling. The seroma swelling did not show up well, no matter what angle of the camera, so I didn’t take a pic. I was told to return on Friday for possible draining. Ideally there will be less fluid, and this process will continue until the amount is low enough for my body to reabsorb. Garment: My new garment arrived and fits good. I was a little concerned about buttock openings, as the seemed like they were too small for my new booty. The garment does provide compression around the buttock-and does not compress the fat transfer areas. What I don’t like is that the compression makes my booty look abnormally shaped because of the size of my butt cheeks, especially in clothes. But just in a certain area. The area underneath my buttock folds where the butt hangs right above my legs. It looks crazy because the garment compresses that area. This in no way affects my BBL, but I am taking about the aesthetics. So I mean that it doesn’t make my butt look perfectly round underneath clothes at the cuff of the butt-well I had on some loose sweats today, but yesterday I wore jeans. I was a little self-conscious about it. I was wondering if people were wondering why the bottom of my butt looked like that. But ultimately, that is the least of my worries, because the garment works. This garment provides excellent thigh, back, upper back, and abdominal compression. Also, it comes with 3 sacral triangles that you insert into a slot in the back. This I love-I wished I would have had this garment or at least the triangle early on for the compression and getting that dip in the back right above the butt where the back and butt curve and meet. The compression to the abdomen is okay-they say they you should be able to pinch the garment-which indicates its not too tight. To be honest, I wanted that thang to fit much tighter-like immediate swelling post-op tight. The compression is good, don’t get me wrong, but I am so pressed to have a lot of pressure on my abdominal area and thigh, more on my abdomen. I looked at ordering an abdominal lipo board, but keep forgetting to do it. Up until last night, I added my exercise waist wrap by sweet sweat (not a waist trainer), but couldn’t get it too tight by myself and didn’t want it to come down on my butt. The picture on the website for the garment shows (see in my photos) a female with her booty fitting perfectly. At least from the side view, she has a petite booty. I don’t want to judge quite yet, as I still have a fair amount of swelling to my booty and abdomen, but these are my initial thoughts. There is great compression on the thighs (reinforced material), under the butt-it wears like a thong underwear which was a little irritating. There is not an opening to do #2, so it does take me a while to get undressed to go the bathroom. Questions for Surgical Coordinator: I had a few questions for the surgical coordinator, Denise, who is absolutely amazing, knowledgeable, and who can speak from personal experience. I could have asked Dr. C, but I liked the fact that she has been there for over 6 years and could tell me verbatim what I needed to know and had the time to do it. I know Dr. C is busy. I showed her how the garment fit on my booty and asked was the correct-she said yes, as I still have a lot of swelling. I told her I expected/wanted it to be tighter, she said no, that was how it should fit. I showed her my booty-I felt that there is flattening or a dent on the middle of the buttock that was previously full (I have been lying on my side 99& of the time with exception to the first 1-2 days, but my butt was elevated and during the first post op-visit-Day, I was told that I could sit on my butt by the nurse which was odd). I asked could it be that the fat died, fat transfer was unsuccessful. She acknowledged the depression or flattening and I explained that below the dent on the left butt cheek is the hardened area from the fat transfer and above the dent is big/full. But on the right buttock it was okay. She indicated that I still had a lot of swelling-it could be possible that the fat transfer didn’t take, however she felt that there is still swelling right above my butt- and it could be that the flattened (is what I call it-compared to the other areas) area swelling has gone down in that area. Also it could be that swelling is going down in the areas of the butt differently. The area in the middle is the area where the fat transfer was injected too, so it could be that it has softened-she said overtime it will all even out and I will have that butt cuff/hang in the bottom of the butt right above the back legs. So bottom line and the answer is always…swelling…changes over the next 1-2 months-I am okay with that. I asked about my navel and should I put a marble (sterilized ofcourse) or ear plug in it to help its shape. She said, I could do that or nothing. She said there is still lots of swelling (I agree) and the navel is very vascular. She said that overtime the extra skin on the sides will retract back into the hole and it will be round. She showed my hers and I seen the extra skin that I have that retracted back-she had to actually spread her navel wide and deep so I could see it. So, I feel way better…and the answer is always…it’s swelling. Lastly, Dr. C indicated I should keep a lot of compression on my abdomen, since I had the seroma. Currently, I don’t feel I have a lot of pressure…I mean I want to be able to breathe and don’t won’t to feel lightheaded, but I need more compression than the garment (should’ve ordered the abd board, will do tonight…I think, SMH). So, I asked did the office have anything. She asked about my binder (its for a 30-45 inch waist) and I explained that it was overstretched and didn’t give me the compression I needed. She grabbed me a new one to try, but also suggested getting a wide ace bandage and wrap it around my waist that way I would be able to target the specific area I needed versus having a binder or something else that wrapped around my butt too. I went to Walgreens-which always seems to be able to have what I need no matter what, especially for this surgery and found a 6 inch ace wrap, I think standard is 3 or 4 inches (the standard size was there as well). Prior to Walgreens, I went to Target and they had the standard size, which I bout. I may use them both and will try them tonight. But still may order the lipo board. Scar and Skin: I am running out of Rose Hip Oil, Vite E 50,000 IU, and my Palmers Scar Therapy for my scar. I decided while I was purchasing scar treatments, I would buy some skin firming lotion while I am healing to help tighten my skin in the lipo areas (thighs, butt, abdomen, flanks, back)-heck everywhere! I googled best body firming lotions (I always google the top or best for almost any product I am considering to read reviews) and the best product rated the highest (9.1/10) was Palmers Skin Firming Lotion! . …You know I said I was at Target first…they didn’t even have this, but they had every other Palmers Coco Butter skin care products for stretch marks, etc., you name it…not hating but just saying. So, of course, I roll up in good ole faithful and trustworthy Walgreen’s and they have it for $7.99-I bought 2 bottles, because I am going to firm up this body before the summer so I am RET-TEY!. I considered other scar treatment oils like-Bio Oil-which was on sail at Walgreens (the large size) for $19.99-I started to buy it at Target, but it was $29.99 (SMH-Is there an app to find and compare local products? If so, please share). I started to by the Bio Oil as I heard about it on RS, but I read the ingredients. While I don’t know how to pronounce any of those ingredients what I do know it this: I compared the ingredients of Bio Oil to what I am currently using Palmers Scar Therapy Oil and it contains a lot of great stuff-but the kicker..it contains silicone and from what I read and can recall Bio Oil doesn’t (but correct me if I am wrong). Silicone strips are what some PS recommends to help heal scars and improve their appearance with significant improvements making them almost invisible. So, I decided to stick with Palmer’s Scar Therapy. I did look at the Silicone strips and will confirm with my PS or the coordinator that I can use them and I will do that too…lol, maybe on some old scars too. I think that about covers everything since my last post. So much to talk about in a week. Oh and before I started writing this (at least 2 hrs ago), I took off my compression garment, I feel like the swelling has increased slightly…maybe the fluid accumulating slowly (seroma) or just daily swelling. I will say this. I know that all the swelling is a part of the process, but I can’t help but to say that I feel that I was flatter immediate post-op than I am now…like now when I look down, all I see is puffiness from my sternum down to my pubic area. I don’t mean to be graphic, but I can even see my clitoris. I was able to right after surgery for a few days, maybe even weeks. I mean…I am just saying. So like Paul in Corinthians 1 & 2 in the Bible. I contradict myself and say/do conflicting things like what I just said…I know…I know…IT”S SWELLING AND NORMAL…but can’t a gal still vent, verbalize, and express feelings and emotions about how her body is looking and transitioning? I say all this to share my experience with you so you will know what to expect, what’s normal, what’s abnormal, what works, what doesn’t, why this, why that-it looks like this and that. I am to go see Dr. C in 2 days (Friday) and will report back anything noteworthy. Last thoughts-the new puppy Rottweiler (well the upkeep and cleaning poo/pee) is a pain in the yo know what-but cute and sweet. Hubby is loving on and caring for his Harley Davidson RoadGlide more than me-it’s his mistress…maybe that’s me, and she is the wifey, because she gets all of his time and attention. My TT scars burns and itches now for the last 2-3 days, mainly on the right side where the seroma and pesky disrespectful tardy drain was taken out. My flanks when moderate touch/pressure burn in pain-swelling still there; this is normal thought. I return to work in 2 weeks, plan on having me a spa day-lymphatic massage, mani & pedi, hair dyed (greys hairs here and there need some coloring/highlights). I plan on having a lymphatic massage soon, I have been a little lazy with that, but I identified 2-3 locations that sound descent.

BBL pics

My photographer was in tonight, so i had her take some BBl pics. As you can see, a lot of swelling has gone down since surgery. I love vie from the back.

Side profiles are okay. Don't expect a Miami Booty. I am okay with that.

He only only injected 420cc on each butt cheek. This was all of the strained and us as usable fat after filtering the tumescent fluid and all the extra fluid that would stick too my butt. He said if he had more he would have transferred fat to the butt dimples.

I still have swelling, I was told I would see a major difference at 2-3 months and you'll see the S curve sillouette ftom my back to butt.

As I mentioned, I am not too happy with side profile, but I know there's still swelling and my butt dimples are present. Dr. C said his main focus was on my central butt, which needed the most fat. If there was more he would have injected to the butt dimples.

My butt is still firm in some areas and will soften up. I am hoping when I get my new garment Monday it will help shape my butt more. Also, I will research some good firming lotions/creams too to use on my thighs, butt, and tummy.

Garment I ordered from my PS office at a significant discount

Ladies,

I ordered a phase 2 garment directly from my PS office. They had their reps help me select what will work best.

While this specific garment does not have the 3 rows of hook & eyes like the fajas a lot of the ladies on RS are talking about, I choose this one for several reasons.

The butt is out which will continue to help shape and support my butt, cutting wholes in the butt of a garment my weaken the garment material.

My PS was in the office when I was selecting the size of the garment and I asked about purchasing over the counter garments from Walmart, sears, etc., he said that Spanx wouldn't give me the compression I needed and the material is different. He said they would provide general support but not the compression I was looking for.

This garment comes with a built in triangle in the back right above the sacral area that provided compression. So I don't have to buy a separate triangle.

Th abdominal area is padded with extra compression. If I need additional abdominal compression once this garment gets to small, I will purchase a lipo board or if I still have swelling in the front of my supra pubis and mons pubis area.

So ladies, if you wanted to order a second garment, check with your PS office first to see if you can get it cheaper through them. This garment was not on Amazon either.

Link: https://marenagroup.com/fbom-open-buttock-capri-length-girdle/

Ths garment cost $144, I was able to get it for $96. It is been shipped to my doorstep. I opted to pay $30 for next day deliver ( comes Monday). This garment fits a 32-34 waist, I am 33, so I am hoping this garment can get me even smaller. Now, that may be expensive compared to some fajas you can get on Amazon, but this wasn't available.

When I heal better, don't thing a sister not gonna use this garment under a sheer sexy dress or something.

This was the other garment I was considering, but decided against after speaking to my PS.

Link:http://allaboutshapewear.com/collections/post-surgery-post-cirugia/products/fajas-disenos-de-prada-backless-strapless-bodysuit-shapewear-11105

Provider Review

Board Certified Plastic Surgeon
120 Waterfront St, National Harbor, Maryland
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