Frustration! I don't think this is normal.... Seromas, additional surgery, more drains after a Tummy Tuck?

Since you have a seroma it is reasonable to place a drain in order to treat it.  For many years I used drains, but have gotten away from that by using internal (quilting) sutures.  It is my firm belief that drains are not necessary in abdominoplasty.  But again, if a seroma persists, drains are reasonable.  Best of luck.

Seromas are more likely to happen in tummy tucks or paniculectomies after massive weight loss. In these cases the fatty layer under the skin does not have the best blood supply, so the tissues don't heel together as quickly and fluid can accumulate. Early drainage is necessary to prevent formation a bursa around the seroma cavity because once the bursa layer forms it will not heal and that layer would need to be removed. If the seroma is not bloody in color a seroma catheter which can be placed in the office by a needle stick might be enough to take care of the problem. I think your surgeon is recommending the right treatment and you should let him take care of this. Hopefully it will resulve with a seroma catheter or a small drain and surgery could be avoided.

Definitely a drain will solve the problem and may eliminate the need of a surgical removal.The thing with a seroma is that it will  prevent the skin to attach to the muscle and may let permanently a cavity among skin and muscle with is not a serious issue but may be noticed. Compression is another very important action to prevent seroma.Trust in your doctor, he will recommend the best for you.Dr. Cardenas5

It is not unusual to have the seroma after body contouring when someone has had massive weight loss. It is very wise to place the drain. This is going to potentially eliminate the seroma. Drain removal is simply done in the office.Earl Stephenson, Jr MD, DDS, FACS

Thank you for your post. Seromas can be painful and cause a cosmetic deformity, as well as sometimes leak. The whole point of drains is to keep a seroma from happening in the first place. If a drainless procedure was performed, and you had a seroma, or you had drains that were pulled and you subsequently had a seroma, then you should be drained, otherwise a capsule builds around the fluid making it permanent. If a capsule builds around the seroma (pseudo bursa or encapsulated seroma) then the only way to remove the seroma is to surgically open the areas and excise the capsule, and close over drains to prevent another seroma from happening. If the seroma is encapsulated and is tight and painful, then it can be confused with just swelling or fat. An ultrasound is useful in distinguishing these and identifying the extent of the seroma. If the seroma is not yet encapsulated, then it is usually loose and has a 'fluid wave' or water bed type feel. Occasionally, a seroma can also become infected, especially if a permanent braided suture was used. This will have a hot, red appearance, and will eventually open up. I have never seen an infection from sterile aspiration of fluid. If seromas continue despite multiple aspirations over an extended period of time, then you need to start thinking about re-openning the incision and excising the entire capsule, both from and back walls, to treat the seroma. Drains need to be placed, internal sutures placed, possibly using a tissue glue or irritant to encourage the tissues to grow together.Best wishes,Pablo Prichard, MD

Seroma is not an uncommon side effect of abdominoplasty/panniculectomy surgery.  Adequate treatment of a seroma often requres placement of a drain for treatment.  You trusted your surgeon to perform your surgery and it seems as though s/he is following you closely, taking good care of you and giving you knowledgable advice.  

Seroma can occur. I try to guard against it by using drains placed during surgery. I would be mor concerned about not evacuating the fluid than with infection risk from the drain itself. Draining a seroma is a basic procedure but it can be more complex if the seroma is deep or diffuse.

It is quite common to have significant seromas after a panniculectomy and tummy tuck.  Based on the volumes that your surgeon aspirated it seems reasonable to utilize a drain.  Those are very high volumes of seroma and placing a drain to remove the fluid would seem to have less potential for complication than allowing those large volumes to accumulate and require recurrent aspiration.  Surgery to remove seroma usually refers to removal of a seroma cavity.  This will not happen until probably at least after 6 weeks to 3 months.However if your plastic surgeon feels there is something beneath the flap which is causing these increased amounts of seroma fluid it is best to follow your plastic surgeons advice.  Based on your history it sounds as though your plastic surgeon is well-informed and on top of your care.