Seromas after plastic surgery

Seromas After Plastic Surgery: Causes, Symptoms and Treatments

August 2, 2017

The word "seroma" derives from the Medieval Latin word serosus (meaning serum) and from the Greek word –oma (meaning tumor). For your recovery, it is important for you to know about seromas after plastic surgery.

What Is A Seroma?

A seroma is a localized collection of serous fluid.  Serous fluid is a combination of blood plasma, protein, water, and inflammatory fluid. Serous fluid is a normal reaction to trauma and especially surgery.

After surgery, most serous fluid develops from serous fluid leaking from the blood circulation through the capillaries. Over time, the leaking capillaries seal and some of the serous fluid is also excreted by serous glands. The serous fluid collects into a localized area. The serous fluid becomes organized and contained by an egg shell or wall of tissue.  Sometimes this shell around the seroma is thin, and other times the seroma shell is thick. A seroma can be the size of a grape, or a seroma can be several inches wide. Very large seromas can encompass the entire abdominal wall from the pelvis to the rib cage and from the hip to hip.

Why Do Seromas Develop?

When two layers of tissue are separated, the body creates serous fluid to stick these layers back together. Serous fluid acts as a natural super glue to seal surfaces together after surgery. Basically, the body tries to heal itself with glue.

Sometimes the body secrets too much serous fluid. When this occurs, the tissue edges float away from each other and are unable to heal. Seromas can develop when there is too much fluid, and the tissue layers are separated. In an attempt to seal and contain the serous fluid, your body makes a wall around the serous fluid. A wall is created around the serous fluid and a seroma develops.

Is It Possible To Avoid Developing A Seroma?

Seromas form because of a collection of serous fluid. There are two methods to prevent seroma formation: one is to minimize seroma fluid formation and the other is to minimize the anatomic space where seroma fluid can collect.

A suction drain can be placed to reduce the formation of serous fluid. The drain is usually placed during surgery. Techniques can be done internally and externally to minimize the anatomic space where serous fluid can collect.

Internally quilting stitches can be placed. Quilting stitches are placed internally from one surface to another surface. Quilting stitches sandwich the tissue surfaces together and obliterate any empty space. With minimal space to collect, it is hard for a seroma to form. Quilting stitches are usually absorbable sutures and are often used during a tummy tuck (abdominoplasty) and the 360 circumferential lower body lift.

External ways to minimize the space between tissues include wearing a compression garment or binder. Typically, after surgery, compression garments are worn for several weeks to reduce seroma creation, decrease swelling (edema), and help flatten scars.

How Does A Seroma Resolve?

Usually, drainage of the serous fluid is the cure for a seroma. Most of the time, seroma drainage is performed in the office.  The skin around the seroma is locally anesthetized, and a needle is inserted and the serous fluid is drained. The serous fluid that is removed is usually clear yellow.

If there is any question about infection, the fluid can be sent to the laboratory for analysis.  Unfortunately, many times after needle aspiration, seromas continue to secrete fluid and return. Seroma recurrence is thought to be due to further secretion of serous fluid from the walls of the seroma cavity. Often, seromas will need to be drained with a needle every several days until they stop draining.

If a seroma is persistent, sometimes your plastic surgeon may inject medication into the seroma cavity. The medication is a sclerosant and aggravates the seroma. The injected sclerosant can accelerate the collapse of the seroma cavity.

If the seroma continues to recur, a drain may need to be inserted. The drain can either be a passive drain (where serous fluid just leaks out) or a suction drain. If a drain does not resolve with the above methods, surgery may be necessary to remove the seroma and its shell. During the surgery, it is important to remove the entire seroma shell. Most plastic surgeons believe that remaining pieces of the seroma shell can further secrete serous fluid. Therefore, if any portion of the seroma shell is left behind, the seroma can reoccur.

How Is A Seroma Diagnosed?

A physical examination can diagnose a seroma. A seroma feels like a small water balloon. Sometimes you can feel the fluid inside the seroma.

If the seroma is large enough, a fluid wave can be elicited.  A fluid wave means that when you press on one area, you create a fluid wave.  This wave of fluid can be seen under the skin. If there is any question on physical examination, an ultrasound can be ordered. If there is still further doubt, an MRI can be ordered.

What Surgeries Are Prone To Develop Seromas?

All surgeries can develop seromas. Surgeries with a high surface area of dissection have an increased chance of developing a seroma.

Procedures such as a tummy tuck, 360 circumferential lower body lift, arm lift, and thigh lift, are prone to developing seromas. Also, surgeries around active joints are more susceptible to seroma development. Seromas are common in arm lifts (brachioplasty) and thigh lifts.

In the arm lift, seromas can often develop around the elbow. To minimize arm seromas drains and compression garments are sometimes used. In the thigh lift, seromas can often develop around the knee. To reduce thigh seromas drains and compression garments are used.

During a tummy tuck (abdominoplasty) or 360 circumferential lower body lift, there are large surfaces which are separated.  Due to the high surface area of dissection, seromas can develop. Quilting stitches and drains can be placed to combat the development of seromas in the abdominal wall.

In conclusion, seromas are a known complication of any surgery. Fortunately, seromas are rare. Furthermore, seromas usually can be treated in the office with needle aspiration. Surgical intervention for the resection of a seroma is very rare.   The development of seromas should not deter you from undergoing plastic surgery. If you have any more questions regarding seromas or plastic surgery in general, please leave a comment at the bottom of this article.

timothy katzen

ABOUT THE AUTHOR

Dr. J. Timothy Katzen is certified by the American Board of Plastic Surgery. Dr. Katzen specializes in reconstructive plastic surgery after massive weight loss. He has written many articles and given lectures around the world about how to perform plastic surgery on patients who have undergone massive weight loss. Dr. Katzen has offices in Beverly Hills and Las Vegas.


Read more articles from Dr. Katzen!