Seroma After Surgery: Causes, Treatment, and Prevention
Seroma-related complications after abdominoplasty and other plastic surgery procedures are quite rare, and can be easily treated in their early stages.
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 is triggered by the injury and subsequent death of cells, typically along an incision or where skin tissue was removed. Unlike blood, serous fluid does not coagulate into a solid or semi-solid state.
Seroma sufferers generally experience swelling, inflammation, tenderness, and bruising roughly 7 – 10 days after their 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 that may last even after the serous fluid has been absorbed by the body.
Luckily, serious seroma-related complications are quite rare, and can be effectively treated when they are addressed in their early stages.
Tummy Tuck Seromas
While seromas can arise after minor surgery, they are most common following more extensive plastic surgery procedures such as breast surgery (breast augmentation or reconstruction following breast cancer), liposuction, and abdominoplasty.
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.
However, seromas often occur after the drains have been removed. As a result, some doctors recommend the use of compression garments in order to promote healing and prevent complications. Seroma is the most common complication following a tummy tuck, and most doctors do not consider it a serious condition.
Note that patients who suffer from obesity are more likely to experience seroma following a tummy tuck, which is one reason why doctors often advise patients to lose weight before the procedure. Seromas can also occur following hernia repair, a procedure that is often performed during diastasis recti surgery.
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 is the primary factor that doctors take into account when determining how serious it is, as 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 he or she 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 your doctor knows so that he or she 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, all of which aim to reduce the volume of fluid contained in the seroma cavity and close the dead space in order to prevent new fluid from collecting.
- Drainage — Draining is typically only recommended for large seromas and patients with higher risk factors. The doctor will remove the fluid through a syringe. Most patients report that seroma drainage is painless, but some doctors will provide a local anesthesia. Larger seromas require several drainage procedures at different junctures throughout the healing process.
- 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, thus reducing the need for future drainage. Vacuum aspiration is often recommended when a higher volume of fluid needs 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 500 milliliters 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 the 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.
- Injections — Following drainage, the doctor may also inject antibiotic solutions — typically tetracycline — or steroids into the seroma cavity. Injections are commonly used alongside drainage treatments, but may also be administered alone. However, injections don’t always helps close seromas on their own, so they are not always recommended as standalone 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 small and non-persistent seromas, doctors may suggest that the patient allow the site to heal itself naturally. In many cases, the body will 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.
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.
An experienced surgeon will also known how to implement drainage tubes in order to prevent the development of seroma in the early phases of healing, and may require that you to wear a compression garment to improve fluid flow. These garments also speed up healing while reducing swelling and bruising.
If you’re experiencing abnormal symptoms following surgery — including increased heart rate, bloody drainage from the seroma, increased redness, a fever exceeding 100.4 degrees Fahrenheit or rapid swelling — make sure to call your doctor immediately.
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