Large amounts of fluid causing me pain after panniculectomy

I had panniculectomy in November 2017. Some locations where my incision is have not healed and I'm in a lot of pain. I have a fever and there's excessive amounts of fluid coming out of one of the deep holes in my incision. I drained 500CCs. My doctor inserted a drain in the deep hole and it's been releasing fluid every day. Please tell me what you think this is? What is causing me to be tired, have a fever and feel pain? Thank you.


F, 60, New Hampshire

I have to make some assumptions here.

Panniculectomy as opposed to an abdominoplasty, is a procedure to remove a large apron of skin and fat from the lower abdomen. This is typically done in patients who either are obese or were obese and have lost a great deal of weight.

Unlike an abdominoplasty, a panniculectomy only removes the apron of skin and fat and does not involve wide release of the entire abdominal skin up to the lowermost rib, muscle tightening, or transposition of the belly button.

Even so, it is not really a lesser procedure because the amount of skin and fat removed can be massive.

The most common complications are seromas and incisional breakdown. Seromas are collections of serum that seeps from the large raw surface created by the surgery.

In nearly 100% of panniculectomies, the surgeon will place one or more drains to suction out any serum before it can accumulate. Even then, when the drains are taken out, seromas can occur.

They may require repeated aspiration with a needle in the surgeon's office until they resolve or, in some cases, drains may have to be re-inserted.

If properly managed, seromas usually resolve and are more of a nuisance than anything else. The danger is that they can become infected and may require opening the abdominal incision, antibiotics, and even hospitalization. You can die from an infected seroma.

Infection should be suspected if the area is red, hot, angry; if there is persistant or worsening pain; if there is fever and/or malaise; and if the character of the fluid turns from clear, yellow serum to cloudy or frankly purulent (pus-like).

Your surgeon needs to address this aggressively and if he/she won't, you need to find another doctor.  

This is a very serious concern. I highly suggest you inform your surgeon and contact the emergency room about this. You should be seen and evaluated for the symptoms you have described here by a board certified plastic surgeon.