What To Know About The Risk Of Seroma After Cosmetic Surgery

Thinking about a tummy tuck post-pregnancy or weight loss? Or perhaps a sculpting liposuction session? In your research, you may have come across something called a seroma. If you’ve had surgery, maybe you’ve even experienced it first hand. It can be likened to having a puddle inside of you. A seroma is “a build-up of tissue or healing fluid inside the body, which can happen after surgical procedures of any type,” says Ryan Neinstein, MD, a board certified plastic and reconstructive surgeon in New York City.

One of the most common cosmetic surgery complications, a seroma is most likely to occur after body contouring surgeries. Here, we’ll talk more about what a seroma is, why it happens, and what you can do to avoid it.

What Causes a Seroma?

“Seroma is a collection of normal body fluid that accumulates in dead spaces,” says Elise Min, MD, board certified plastic and reconstructive surgeon at Cassileth Plastic Surgery in Beverly Hills. The clear (i.e. serous) fluid pools under the skin and is usually found near incisions. It can happen soon after surgery or, in some cases, weeks later.

While it’s natural for some amount of body fluid to accumulate at a surgical site, it becomes problematic if it does not subside. “Generally, [the fluids] get reabsorbed by the body in the postoperative period and go away on its own,” Dr. Min explains. “Sometimes, too much fluid can accumulate and form a pocket of fluid collection.” This is most common, she adds, after operations “where a surgical space is created” due to tissue removal. In cosmetic surgery, this can include:

• Abdominoplasty (a.k.a. tummy tuck)
• Breast surgery
• Lifts (such as arm lift, butt lift, or thigh lift)
• Liposuction

As Dr. Neinstein explains, our bodies respond to the inflammation from surgery by creating fluid and scar tissue. “When the healing capacity is overwhelmed, the fluid becomes apparent and a seroma develops,” he shares. “This can happen because surgery was aggressive, too much energy – such as a laser – was applied, no drains were used, or improper garments or aftercare were applied.” Other times, he says, seromas can happen for no reason at all.

Symptoms of a Seroma After Cosmetic Surgery

While they can usually be identified via a physical exam, an ultrasound may be needed to confirm a seroma diagnosis. Most seromas don’t pose a health risk to the patient. They usually look like a swollen lump and feel like a cyst that may or may not be tender to the touch. Clear discharge is common and changes in color may be indicative of an infection that requires medical attention. If the seroma becomes infected, it may look red and feel painful and/or warm to the touch. An infected seromas can lead to the formation of an abscess.

How to Treat a Sermona After Cosmetic Surgery

How a seroma is treated depends on its size. A small seroma usually goes away on its own with compression, but larger ones may need professional intervention. “Some may require aspiration in the clinic by the physician,” Dr. Mi says. Dr. Neinstein says that seromas can be dealt with in a minor office procedure where the fluid is drained and pressure is applied through dressings and garments to prevent re-accumulation.

If a large or infected seroma is left untreated, it may eventually require a full removal of the seroma and the fibrous capsule that comes to surround it, Dr. Min cautions. In very rare cases, calcification (read: hardening) of the fluid may occur. “Once in a while, the seroma can harden and form a scar ball inside that may need to be removed surgically,” Dr. Neinstein notes. “Luckily, these are rare.”

How to Prevent a Seroma After Cosmetic Surgery

In the case of seroma, like so many things, the best treatment is prevention. That prevention begins in the operating room. In his textbook chapters and masterclasses on liposuction, Dr. Neinstein shares many strategies to reduce the occurrence of seroma. “It all starts with finesse surgical technique and gentle handling of tissues,” he says. “After this, I discuss an outlet for surgical fluid to get out.” Those outlets can include various forms of drains or leaving small liposuction sites open so that excess fluid can drain.

Dr. Min adds that surgeons try to prevent seromas by either placing drains in the surgical space or by placing progressive tension sutures in the surgical site internally. “All of the techniques strive to minimize the dead space created during the surgery,” she says.

After surgery, lymphatic drainage massages can help reduce the risk of seroma by promoting healing, Dr. Neinstein says. Additionally, it’s important to follow your post-op instructions to a T. Beyond healthy eating and proper rest, they will likely include recommendations for elevating the treatment area and wearing compression garments and tell you when to return to your surgeon to have drains removed. If you need help assembling your post-op recovery kit, we’ve got guides to the best meal plans, pillows, and compression garments to consider after cosmetic surgery.

It should be noted that, in some cases, seroma is unavoidable – no matter your surgeon's or your own best efforts. If you think you might have a seroma, contact your provider. Early diagnosis and treatment can be key to preventing infection.