Sometimes the Atlantic Coast Aesthetics Question of the Week we get is much more specific than usual. While the advice our founder and Chief Medical Officer, Dr. Thomas Pane, gives in his weekly Google Hangout is not intended to replace an in-person direct examination of the patient by medical professionals, questions like this are particularly interesting because they address things that can and sometimes do happen in the aftermath of surgery, even when aftercare protocols are followed precisely. This week’s question came in via email to ACA’s website: “I had a tummy tuck in mid-December [roughly six weeks prior to the question] and I’ve noticed severe abdominal swelling. Is it possible that I have a seroma or hematoma, and what do I do about it?”
Dr. Pane says that the first question is whether or not the patient’s surgeon seems unduly concerned about the swelling. He notes that some post-operative swelling is normal and to be expected in the flap area, which is the portion of the abdominal skin that is brought down and stretched into place as part of the procedure. He said this is typical and not cause for alarm by itself.
A seroma is a fluid buildup that can occur beneath the flap area. This differs from a hematoma in that the fluid is largely benign and has low or no blood content, while a hematoma is essentially a runaway bruise or pooling of blood in a given area that may indicate a serious breach of the integrity of the blood vessels surrounding the area. While to the untrained eye these can look very similar, a seroma is the kind of problem that drains are placed during a tummy tuck to prevent, while a hematoma is a problem that may require surgical intervention to correct.
Dr. Pane observes that the way he does tummy tuck procedures, there is nearly no incidence of seroma due to drain placement and other factors. However, he is familiar with them from helping patients who have had procedures like tummy tucks elsewhere and ended up with seromas. The first order of business, he says, is to get a clinical examination to ensure that the problem is accurately diagnosed and treated. The wrong kind of treatment in these cases can sometimes be worse than no treatment at all, so getting the problem looked into promptly must always be the first step. If the first doctor’s opinion and/or method of treatment does not satisfy the patient, it is always a good idea to seek a second opinion as to the type and severity of the problem.