A seroma is a pocket of clear serous fluid that sometimes develops in the body after surgery. When small blood vessels are disrupted, blood plasma can seep out into the surgical area. Further, the inflammatory process can lead to additional fluid exudate. Seromas are different from hematoma (collections of blood), and from abscesses (collections of pus). Seromas can also sometimes be caused by injury, such as when the initial swelling from a blow or fall does not fully subside. The remaining fluid causes a seroma that the body usually gradually absorbs over time (often taking many days or weeks); however, a knot of calcified tissue sometimes remains.
Seromas are particularly common after some plastic surgical procedures where large areas are undermined, leading to large raw surfaces. Seromas are usually preventable by placement of a drain at the time of surgery. However, seromas can develop after the drain is removed. Further, seromas can occur if care is not taken and a patient inadvertently pulls a drain out after surgery. Many patients find that it makes their initial recovery period more difficult, and some need repeated visits to their doctor to have the seroma fluid drained.
Pictured above is about 35 cc of seroma fluid that was drained from a patient following removal of a large lipoma. The patient accidentally pulled out her drain (that was placed during surgery), on the first post-operative night. As a result, the fluid accumulated at the surgical site and required removal with needle aspiration.
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what is the best way to care for a seroma? do u keep it cor covered with gauze?clean anddry? or let fluid be exposed to air ?
Marie,
Thank you for your questions. Seromas are fluid collections that exist within soft tissues. They are technically not open cavities, so you should not be able to cover it or expose it to the open air. Seromas need to be treated surgically, either by aspirating with a needle and syringe, or in the case of recurrent seromas, by excision of the cavity. Hope this helps.
Best,
Kevin Brenner, MD, FACS
Hi Dr. Brenner
I had a breast reduction and lift nearly a month ago. I had drains in for a week and the surgeon pulled them even though I was producing well over 20 cc per side per day. A few days later my left side dehisced and fluid came pouring out. It was horrible. I was then subjected to 2 hours of “revision” surgery with just local alone in his office freezing and wet from fluid leaking on me as I was shaking the whole time. He cut more skin off and put the drains back in. He pulled them a week later (although I strongly expressed my concern here). Then I filled right up and have been miserable. He said this has never happened to him (insinuating its something odd about me) and told me I will have to come in 2-3x per week to have fluid drained. Very condescending. My dad is a surgeon and mom is a nurse practitioner and both have expressed concerns about this being a function of technique. I dont know what to think. I now have uneven breasts (which I understand may be a function of the fluid) and horrendous looking incision areas/scars from his little “revision.” I am very worried and disgusted and dont know that I trust him. He just doesnt seem to really care much and I always feel like it is a bother to him when I go in for these aspirations. I am unclear what to expect going forward. From what I understand it seems unusual to have this problem on both sides especially after having drains in twice for a total of 2 weeks. Will this eventually resolve? Do you think this has to possibly do with surgical technique? Is it standard practice to do a large “revision” under local alone in an office? The result is worse than what I started with. Do you think another surgeon is going to be comfortable offering me a second opinion on this ongoing postop plan or would they be reluctant to jump into this mess? I really need some advice from a trustworthy source. Thank you so much for any words you can offer. By the way I am on the East Coast.
Lisa,
Thank you for your note. I sent you an email with detailed instructions.
I look forward to hearing from you.
Best,
Kevin Brenner, MD, FACS
What would you call a collection of fluid that is open? I have a 1″ hole in my belly that goes down 7″ or more into a pocket of fluid. It is not pus, but the fluid is not clear either. It’s yellowish and very sticky. It formed after an infected mesh panel was removed. I have to keep it packed and it drains substantially.
It sounds to me like you have a sinus tract. This is usually something that can be repaired fairly easily. If you would like to learn more, please call my office at 310-777-5400. Thanks,
Kevin Brenner, MD, FACS