Seroma-related complications after abdominoplasty and other plastic surgery procedures are quite rare, and can be easily treated in their early stages.
Though uncommon and not life threatening, it is important to recognize the early signs of seroma and to bring them to the attention of your doctor. Treating seroma early can help to prevent more serious issues like a secondary infection.
What is seroma?
Seroma is a collection of lymph fluid that develops under the surface of the skin following a surgical procedure. Also known as serum or serous fluid, this clear discharge of fluid from the lymph nodes is triggered by the injury and subsequent death of cells, typically along an incision or where skin tissue was removed.
Some of the most common seroma symptoms are swelling, inflammation, tenderness, and bruising roughly seven to ten days after surgical drains have been removed. This buildup of blood plasma and inflammatory fluid can last for several months or even years.
In some cases, seromas will cause the tissue surrounding the area to harden over time, creating a knot of calcified scar-like tissue. This knot can remain even after the serous fluid has been absorbed by the body.
Tummy tuck seromas
While seromas can occur after even minor surgery, they are most common following more extensive plastic surgery procedures. Breast surgery (breast reconstruction following breast cancer treatment or breast augmentation), liposuction, and abdominoplasty are among the procedures that are most likely to lead to seroma formation.
After an abdominoplasty or tummy tuck surgery, the plastic surgeon will typically install drainage tubes around the treatment site in order to reduce fluid buildup during the healing process.
Unfortunately, seromas typically form after the drains have been removed. To minimize this risk, healthcare professionals typically recommend the use of compression garments.
Seroma is the most common complication following a tummy tuck, but most doctors do not consider it a serious condition. Seromas can also occur following hernia repair, a procedure that is often performed during diastasis recti surgery.
It is important to note that patients who suffer from obesity are more likely to experience seroma following a tummy tuck. This is one reason why doctors often advise patients to lose weight before the procedure.
Seroma infection and risk factors
In general, seromas are not considered life-threatening or dangerous. However, they can lead to several other complications when not properly treated.
The size of the seroma typically determines how serious the issue is. Larger seromas are more likely to trigger a secondary infection at the site.
If you are experiencing symptoms of seroma for several days following the removal of surgical drains, be sure to contact your doctor immediately so that they can treat the seroma and prevent infection.
Seek immediate medical attention if you experience any of the following symptoms:
- Abnormal pulse rate
- An increase in pain, swelling, and tenderness around the seroma
- Pus or bloody drainage from the seroma or incision site
Infection caused by a postoperative seroma is called a surgical site seroma infection (SSI). Your risk factor is higher if you have a compromised immune system or another condition that may delay or prevent your body’s ability to properly manage the infection.
If you have had a history of seromas following surgical procedures, make sure that your doctor knows so they can take extra precautions during recovery.
Not all seromas require treatment. Often, the body will naturally reabsorb the fluid over time. In more serious cases, doctors will perform tests using an ultrasound in order to determine the depth and volume of the fluid.
There are various seroma treatment options available. These treatments aim to reduce the fluid contained in the seroma cavity and prevent new fluid from collecting.
- Vacuum aspiration
Vacuum-assisted seroma drainage techniques — such as the Royal Marsden Technique — can be used to aspirate large volumes of seroma fluid in a single sitting. This reduces the need for multiple future drainage sessions. Vacuum aspiration is often recommended when higher volumes of fluid need to be removed.
- Punctures (fine-needle aspiration)
By creating several individual fine-needle punctures in the seroma, the doctor is able to remove up to 16 oz of fluid. This is a good option for those with larger seromas, but does require between five and seven sessions — usually performed over several days — to completely remove all of the clear fluid.
- Surgical removal
In instances where the seroma returns despite regular draining and other treatments, doctors may recommend removing the seroma through surgery. A persistent and permanent seroma can be treated surgically by suturing the cavity shut, or by removing the seroma altogether.
Following the removal of fluid, a doctor may also inject antibiotic solutions — typically tetracycline — or steroids into the seroma cavity. Injections don’t always help to close seromas on their own, so they are not usually recommended as standalone treatments.
Injections are commonly used alongside drainage treatments. Steroid injections may provide better results than antibiotics, but many doctors caution against the use of these substances due to their many side effects.
- Natural healing
In cases of non-persistent and small seromas, doctors may suggest that the patient allow the site to heal itself naturally. The body will often absorb the fluid on its own.
Seroma healing varies from person to person and can take anywhere from several weeks to a year, so it’s important to have a proper medical evaluation performed before deciding to take the natural healing route.
A doctor can remove serous fluid using a syringe to drain seromas. This is typically only recommended for large seromas and for patients with higher risk factors.
Most patients report that serous drainage is painless, but some doctors will provide local anesthesia. Draining seromas may require repeated procedures throughout the healing process.
The best way to prevent seroma is to choose a board-certified plastic surgeon with several years of experience. Unfortunately, poor work by your plastic surgeon increases the odds that you will develop seromas. Scheduling follow-up appointment can help with early seroma detection.
An experienced surgeon will also known how to best implement drainage tubes to prevent the development of seroma in the early phases of healing.
If you’re experiencing abnormal symptoms following surgery — including a rapid heart rate, bloody drainage from the seroma, increased redness, a fever exceeding 100.4 ° F, or rapid swelling — make sure to call your doctor immediately.
- Fitzgerald, J. E., Hayes, A. J., & Strauss, D. C. (2011). Vacuum-assisted sterile drainage of large post-operative seromas: the Royal Marsden technique. Annals of the Royal College of Surgeons of England, 93(8), 646-7. ncbi.nlm.nih.gov/pmc/articles/PMC3566696
- Smith, M. M., Lin, M. P., Hovsepian, R. V., Wood, D., Nguyen, T., Evans, G. R., & Wirth, G. A. (2009). Postoperative seroma formation after abdominoplasty with placement of continuous infusion local anesthetic pain pump. The Canadian journal of plastic surgery/ Journal canadien de chirurgie plastique, 17(4), 127-9. ncbi.nlm.nih.gov/pmc/articles/PMC2827279