Post Operative Swelling Stages
In my previous blog post about post operative tummy tuck swelling I talked about how the blood supply is disrupted to different degrees using the two different types of tummy tuck techniques (standard vs. Lockwood). In summary, the more skin that is elevated and separated from the muscle layer, the more blood supply disruption you have. On this post we will address swelling of the tissues after tummy tuck and why compression garments following surgery are important to reduce swelling.
The body is made mostly of water, and there is a constant fluid leakage from the tissues balanced by reuptake of fluid into the lymphatic drainage system. When the lymphatic system is impaired, we get fluid accumulations. The fluid can accumulate between the tissues as interstitial fluid (like a soaked sponge), or outside of the tissues as a seroma (like a sac of fluid). It can also accumulate at some distance from the operative site, usually the upper thighs or legs.
The drawing above illustrates the various types of fluid accumulation following surgery. As you move from left to right on the illustration you have increasing swelling to result in these conditions:
normal skin ——> normal swelling ———- > seroma———>
Fluid accumulation can happen early on in the postoperative period. When the body is in the acute healing phase it produces a lot of fluid. There are also a lot of tissues cut by the surgery, so there is leakage from those areas. The lymphatic channels themselves, which are used for drainage of the fluid, are cut and interrupted, so drainage of the fluids is impaired. This is to be expected. Since we know that there will be fluid accumulation after surgery, plastic surgeons prepare for this by utilizing drains during the post operative period.
Swelling can also happen after the acute healing phase is over, during the prolonged healing phase. The long incision line across the lower abdomen interrupts a lot of lymphatic channels. Since drainage of the lymphatics goes from the extremities to the heart, the incision path blocks drainage until lymphatic channels get reestablished. This can take weeks or months. The swelling is manifested as swelling in the upper thighs, and in some cases in the lower legs. The abdominal skin flap can stay swollen due to lymphatic blockage weeks after surgery. This type of swelling requires compression, because swollen tissues themselves can cause more scarring.
Control of swelling starts with surgical planning. As was described in my earlier post describing the Lockwood technique of tummy tuck, the less you separate the tissues the better. This is because there is less empty space for fluid to accumulate, less tissue from which fluid leaks, more intact lymphatics to drain fluid, and tissues can heal faster. I prefer the Lockwood technique because separates less tissues than the standard technique After surgery, compression is very important. It prevents fluid leakage from the tissues, and once it occurs, the pressure forces it back into whatever drainage channels are available (drains or lymphatics). Tissues heal better and faster when there is minimal swelling.
The type of compression is important. Too much compression at a given point can stop blood flow and cause tissue death. Too little, and fluid accumulates. In my opinion abdominal binders (wrap around type) are inadequate because they shift and the shearing from it can disrupt the healing of the abdominal flap to the muscle underneath. Secondly, they can obstruct flow from the extremities back to the heart. This is why some people with abdominal binders can have swelling in the upper thighs.
To control swelling, I only use medical grade compression garments that go from the rib cage to just above the knees, with shoulder straps to prevent creases. The compression is uniform so there is not too much pressure in any one site. The compression in the thighs prevents any fluid buildup in the upper thighs and legs. In addition, in areas where I have separated a lot of tissue I put some foam pads to apply gentle extra pressure and prevent seromas. The compression garments are left continuously for two weeks (except for taking showers or baths), and during the day for another two weeks. This is a month of wearing garments. It is important to wear the garment for this entire period so that you are compressed during both periods of fluid accumulation, the acute (immediately following surgery) and prolonged healing phases (2-4 weeks out).
In summary, my experience has been that post operative swelling can be easily controlled with:
1) the appropriate surgical design (Lockwood technique)
2) prompt and prolonged compression with medical grade compression garments
Ricardo L Rodriguez, MD
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22 Comments
July 3, 2010 at 12:43 pm
It will resolve,you just have to be patient. It is surgery, and people forget that the body has a lot of work to do.
Luckily, it seems your surgeon is in top of it and has given you the access to reach him as soon as you need it.
So relax, you are in good hands.
July 3, 2010 at 4:04 am
Hi Dr. Rodriquez. Thanks for answering my questions. Yesterday I went to my doctor and they decided to go ahead and remove my remaining drain but I do have a little swelling still in my lower abdomen. He said he doesn’t believe it looks like a seroma, but he mentioned how to “test” it myself and to call them immediately if my skin “bounces” back like a waterbed like you mentioned. I don’t think it’s doing that……..it just seems swollen but I don’t see a waterbed or ripple effect when I press on it. The swelling is along my incision line…….it’s like all my swelling traveled south and that’s why my upper torso is so flat and not swollen at all.
I am definitely going to order another compression garment. This binder has done nothing it seems. I was thinking of a binder that goes over my thighs and all the way up to the ribs…..because I had lipo in the hips and they are swollen as well.
Honestly, I researched tummy tucks a lot (from what I thought) and I had no idea that swelling would be such an issue. I sort of wish I had my tummy tuck using the method you use….the Lockwood technique. It seems like it’s so much less complicated. The swelling can be quite depressing and at first was making me wonder if having a tummy tuck was the right decision……but I try to remind myself that it won’t be swollen forever.
June 29, 2010 at 9:53 am
Michelle:
There are two possible explanations for this.
The first one is that sometimes fluid pockets are isolated from each other by areas where tissues have healed. So one drain ( the one that is still there is surrounded by healing tissue) can be draining very little, while there is a large pocket of fluid beside it.
The second one is that because of the seroma, the tissues themselves are swollen.
There is a simple way to tell. Put firm pressure with one finger for a couple of seconds in the most swollen part. Release suddenly. If the skin bounces back like a waterbed, you probably have more seroma fluid underneath. If there is an indentation where you put the finger in, the tissues themselves are swollen.
Let me know what happens.
June 29, 2010 at 9:42 am
Michelle:
Go ahead and order the compression garment.
I still think you are at risk of developing more fluid, so wear the garment 24/7. There is a risk that the seroma could get infected so I recommend you stay in close contact with your doctor.
At the first sign of redness, pain , or fever alert your doctor as you may need antibiotics. If the swelling persists you may need a needle aspiration. Regretfully, seromas are not that uncommon after a conventional tummy tuck with dissection all the way to the rib margin. That is why I prefer the Lockwood method of dissection.
June 29, 2010 at 9:34 am
Sofia:
I am sorry you are still having discomfort.
At two months after surgery, the best option you have is to get in contact with your surgeon. He knows exactly what he did and what technique he used, therefore he will have the best clue as to what is going on now.
It may be anything from normal postoperative swelling with his technique to a seroma.
You need to get very assertive with his office and demand to be seen ASAP. Tell the office staff that you are having problems. If they do not respond quickly, tell them that if you are not seen quickly, you will ned to go see somebody else and request a copy of your medical records. That should elicit a response.
You do need to be seen in person. An online consult at this point would only be speculative. You need a secure diagnosis.
June 26, 2010 at 11:56 am
I wanted to add, when I say that the fluids came out of my “incision” site, I don’t mean my tummy tuck insicion site. I meant the small area where the tube had been inserted. I was actually in my doctor’s office and we were trying to get the tape removed and the drain just fell out. She sort of massaged my lower abdomen and A LOT of fluid just came gushing out. Today I feel like I’m just as swollen as yesterday. The output on this second drain isn’t much and I don’t understand why……because I’m obviously still very swollen.
June 26, 2010 at 11:53 am
I had an extended tummy tuck 2 weeks ago and yesterday I went in to get my 2 drains removed, but I am having swelling in my lower abdomen….not in the upper part at all, just the lower section. One of the drains had come out before I even go to the doctor’s office. My body just sort of rejected it and has been pushing it out until eventually, it came completely out. So my doctor decided to leave this second drain in for a few more days. I’ve been wearing a binder that they provided me with and I agree that I just don’t feel like the binder is doing anything at all. It shifts around so much and it really doesn’t even feel tight even when I pull it as tight as possible.
When my tube fell out yesterday I pressed on my tummy and fluids came gushing out of my incision site literally and I watched the swelling go down. I feel like if I had been wearing a better medical compression garment then this swelling could have been prevented, but my doctor’s office said that the binder should be all I need. Do you think I should go ahead and order a compression garment online and what type do you suggest? I had an extended tummy tuck with lipo of my back and my hips. Thanks
June 25, 2010 at 10:04 pm
I AM MORE THEN 2 MONTHS AFTER TUMMY TUCK OPERATION, I STILL HAVE THE DRAINAGE, I AM BLOADING & HAVE A BIG DISCOMFORT INSIDE OF MY STOMACK.PLEASE RESPOND TO ME ASAP.CAN YOU GIVE ME SOME ADVICE OR INFORMATION. WHAT TO DO?THANKS A MILLION
May 20, 2010 at 6:40 pm
Beth:
Your problem sounds very involved. I would not even venture to guess what is happening in your situation.
My best suggestion is to go visit a Plastic surgeon so he can examine you.
We could do a virtual consultation here, but that would only be an overview of your options because to make any real decisions, a case like yours really has to be evaluated in person.
Call Kelly at kelly@cosmeticsurg.net for more info.
May 19, 2010 at 9:14 pm
Hi,
I had a kidney transplant in November which included a hernia repair using mesh. Immediately after the surgery I had vaginal swelling and fluid pockets in my abdomen. The fluid was removed from my abdomen on 3 different occasions at Interventional Radiology during Nov. and Dec., but the vaginal swelling never went away.
After the last fluid removal, I wore a wrap around binder on my abdomen. During Feb., March and April, I started accumulating fluid, but without fluid pockets, and the fluid didn’t show up on CT or ultrasound, but my abdomen and vagina were very loose, jiggly, etc. I was told the fluid was probably in the tissues. Surgeon through it could be the mesh causing the problem, so it was removed a couple weeks ago, major surgery cut on the same incision as the transplant, 5 days in the hospital. The mesh was tangled up inside when he went in. My incision is about 12″ - 13″ long. My surgeon also gave me a mini “tummy tuck”, which he typically does for me when he has to go in there (2 transplants, gall bladder removal & hernia repair, etc.). I hoped this was the culprit of all of my swelling, but my vagina is still very swollen and jiggly, and my upper inner thighs are very “heavy”. If I put my leg horizontal and twist it to the side, and let the inner thigh drop with gravity, it feels and looks like a water balloon. It’s very heavy. My vagina sticks to my leg when I sit.
I was just wondering if the binder I was wearing pushed the fluid down to my upper thighs. If so, is there anything I can do to get rid of this. I am so uncomfortable, and I think my transplant surgeon has done all that he can do. I was concerned that when the mesh came out, my legs and vagina wouldn’t resolve itself, although my abdomen is pretty much back to normal (I think due to the removal of all the loose skin from the ascites early on). How can I know if there is fluid in there, if it’s in the tissues, etc. I truly do not believe it is fat, because this all happened suddenly, and the rest of my body is of average size. And I don’t think I would gain fat in my vagina! So it is the vagina and upper inner thighs that I am worried about.
Any suggestions?
Thanks!
May 11, 2010 at 6:22 pm
Leigh:
You can tan under a bathing suit. I used to be a swimmer, so I know about tanning under a bathing suit. You should wear a sunscreen over the scar otherwise the scar will turn dark.
Otherwise, all these questions you should be really talking them over with your surgeon. He knows the details of his surgery best, and it would not be appropriate for me to comment.
Enjoy your summer with your new body!
May 11, 2010 at 11:06 am
how do you care for a tummy tuck incision, during the summer. does the sun penetrate bathing suits , will the suns rays cause the incision to become darker or turn white? what is best as far as ointments go to apply to the area as it heals. mine is 3 months old. my surgeon said just to use regular lotion, .also i am taking yoga now, is it OK to stretch abdomen muscles when they feel tight? will it loosen them ,
thank you..
May 4, 2010 at 7:51 am
Leigh:
After any body contouring procedure, there is fat redistribution throughout the body.
As for the efffects of diet, surgery, and excercise, read this blogpost.
Remember, weight is a function of calories in/calories out. You may need to start a calorie count of your food intake to see where you stand. Hope this helps!
April 30, 2010 at 11:35 am
I had a tummy tuck 1/26/10, I have noticed a 10 pound weight gain, I amhave exorcizing and eating right, and not lost 1 pound. My upper thigh size is larger, and my back seems to have gained fat .. I drink 64 oz. of h2o a day, walf 45-60 mins. 4-5 times a week, and just started Yoga. this weight is not moving! questions: after a tummy tuck, does fat collect else where like the back, thighs,arms.
could i still be retaining fluid 3 months later?
I used a waist binder, is the fluid that is in my thighs permanent?
April 11, 2010 at 9:56 am
Rosie:
The amount of postoperative swelling depends not only on surgeon technique, but on individual patient healing rates.
The only person fit to answer this question is your surgeon, because he knows what technique he used and has a good ballpark idea of how long his patients take to heal. Secondly, he can look at you directly and form a judgement as to how far along the process you are. Don’t be afraid to call your doctor for any questions or concerns. You paid him a lot of money not for a professional service, not just surgery, and you should expect him to answer your questions.
I always give my patients my cell phone number so they can reach me at all times, that keeps it simple and direct.
April 10, 2010 at 2:30 pm
i had a tummy tuck/lipo to back and flanks 3wks ago, i just wanted to know how long to expect swelling, i notice the swelling above incision i wear my binder qd just wanted a ball park figure thanks
March 17, 2010 at 9:10 pm
It is really hard to make judgements about a surgery performed by somebody else, without having examined you, etc.
I would suggest you call your doctor’s office tomorrow and tell them your concerns and let them know you are upset.
If you are dissatisfied with his answer, your next option is to get a second opinion in person. Whatever you do, do not take advice online, as the doctor cannot be aware of all the details necessary to give you the best advice.
Good luck and let us know what happens!
March 15, 2010 at 2:30 pm
I had a tummy tuck with body contouring. I am 25 days out and I continue to develop fluid. Once a week the PS will asperate the fluid with a needle. The problem is… I am accummulating fluid right after he asperates me and I have to wait an entire week until the next removal of fluid. I have been complaing about major back pain and upper thigh pain. My regular doctor and Physical Therapist said the pain is from fluid accumulation. The fluid is causing pressure to my spine. Can fluid cause this type of pain in my back and leg? Please help me. I would truly prefer the doctor put in a drain so that I don’t have such an accumulation by the time I go back to him on my weekly visit. Please let me know your suggestion.
August 14, 2009 at 5:25 pm
You really need to contact your surgeon to handle this.
You have had a complication, which is not unusual, but now you need to be under close supervision. This is not a problem to troubleshoot over the internet. You really need to see your doctor and ask him questions until you are satisfied you know what’s going on.
Above all, don’t take advice over the internet for a problem that needs to be handled in person.
Go see your doctor or his nurse in person today.
August 14, 2009 at 8:23 am
I’ve had tummy tuck /liposuction pre tuck (by another surgeon) and was placed on drains which was inserted for 3 days. I now have an ifection in the center of the wound which is not healed. I have accumilation of fluid which one day when I pressed my tummy came pouring out from the unhealed section. About 5 minutes later all that fluid has build up again. I am currently on co-amoxiclav 500/125mg and metrodadole 400mg. I would like to know if this fluid build -up after 3 weeks of the op. When I sit it the fluid seems to be pushed up forming a bulge until I stand for about 2 minutes where it will even up again. Do I have cause to worrry? I know the swelling will take some time to go down, but it’s this fluid that leaks out that is my concern. I would like to add that I do wear the medical grade compression garment with the straps. I only took it off once to wash it then back on it went. Any advice you can give me please?
June 1, 2009 at 9:47 am
It sounds like you may have a seroma, or fluid collection.
Call your doctor and tell him you think you have fluid. You need to do this as soon as possible.
May 31, 2009 at 11:44 pm
I just had a tummy ;tuck two weeks ago.. I have been wearing the compression wrap the doctor gave me but after reading what you suggest, I would like to get the medical grade compression garments. Can you tell me where I can get them and the cost. When I touch my stomack it feels like fluid running from side to side. Help thanks
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