Sometimes after an abdominoplasty or liposuction serum is produced beneath the skin. This leads to a collection of fluid called a seroma. This fluid will not clot and contains albumin, fat and red blood cells. It is clear and yellow in color.

 

A seroma is usually noticed about 7-10 days after surgery and a few days after drains are removed. It is seen as a swelling in the area undermined at surgery. It is more common in the lower abdomen than the upper. Patients often say they can feel fluid under the skin. When they move it is not uncommon to feel this fluid move as well.

 

The initial treatment is to remove the fluid with a needle. This is called "aspiration". Often 150 ml of fluid is removed each time. This is done once or twice a week and within a month the fluid has usually absorbed. A pressure dressing is usually applied a at the same time to reduce the size of the space under the skin and increase the likelihood of the pocket closing.

 

The fluid is rich in protein so it is important that the patient take extra fluids and protein during this time. There is a small risk of the fluid becoming infected so many surgeons use antibiotics.

 

If the seroma persists then it can cause a layer of fluid producing tissue to line the pocket under the skin. If this happens then surgery is often needed. Several methods have been described. Some surgeons like to remove the lining layer. Others stitch the pocket closed with quilting stitches. In almost all cases another drain is used.

 

In some cases irritant fluids may be instilled into the pocket in an attempt to produce inflammation and closure of the pocket. Whether this helps or encourages more fluid to be made is unclear and the technique is not commonly used today.