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CosmeticSurg Blog

Dr. Rodriguez discusses Plastic Surgery, Medicine, and Stem Cell Research

Tummy Tuck Complications – Infection, Wound Separation, Seroma, Hematoma

There have been several comments recently on one of my previous blog posts about swelling after a tummy tuck. Swelling is only one of the possible complications that can occur following a tummy tuck procedure. Other post-op abdominoplasty complications can be subdivided into a few major classifications: Infection, Wound Separation, and Fluid Collections (Hematoma and Seromas).

INFECTION AFTER A TUMMY TUCK

bottle of antibioticsMost surgeons give patients pre-operative antibiotics so wound infection is not as big a problem as it used to be. Ask your surgeon if he will be giving you preoperative antibiotics and make sure you are not allergic!

Infections can be minor, such as a suture abscess. However, they can also be life threatening, like those of MRSA.

A suture abscess is typically not dangerous, and it’s caused by the body trying to dissolve away some of the absorbable sutures that are placed in the deep layers of tissue to hold the tissue together. It is easily taken care of by lancing the area under a local anesthetic, and packing the small puncture with a medicated gauze. Usually additional antibiotics are not needed unless the patient has fever and redness over an extended area.

With respect to MRSA, as a precaution I routinely ask patients if they, or anyone in their family, has had an episode of MRSA (Methcillin Resistant Staph Aureus). This can be a very dangerous infection after surgery. If the patient has a history of MRSA or exposure, we will do a swab culture of the nose (where MRSA frequently resides), and will give specific antibiotics against MRSA at the time of surgery.

Remedy: Taking active steps to prevent infection is the best remedy.

WOUND SEPARATION AFTER A TUMMY TUCK

sterilized medical gauzeThis looks dramatic to the patient, because the patient thinks that the separation is very deep. However, it is not, as the separation only goes to the muscle wall. Wounds can separate for the following reasons:

  1. Excess skin tension if too much skin was taken out during the procedure. The best way to prevent this is for the surgeon to excise the skin in surgery not according to ‘the pre drawn pattern’, but by making sure the closure will be more than adequate well before the actual cutting is made!
  2. The wound edge heals poorly because of poor blood supply. This is more common with techniques that elevate the skin all the way up to the skin margins.

The Lockwood technique that I use for the tummy tuck dissection is excellent because it does less undermining and preserves most of the blood supply.

Remedy: Small wound separations are easily taken care of by packing the wound with medicated gauze. Slightly larger wound separations, or those caused by tension, can be taken care of by a suction device called a “Vac Dressing” manufactured by KCI. Large wound separations caused by poor blood supply may need revision and re-approximation of the wound edges in a procedure room.

FLUID COLLECTIONS AFTER A TUMMY TUCK

Fluid collections are more common when there is a lot of space created between the abdominal skin and the underlying muscle. Fluid can easily accumulate in this space and complicate the healing process. For more detailed information, see my blog post about post operative tummy tuck swelling and seromas, Tummy Tucks and How To Reduce Swelling and Eliminate Fluid Collections.

In summary, the different type of fluid collections associated with tummy tucks are seroma and hematoma.

Seroma

A Seroma is a collection of wound fluid. It is mostly seen when the patient has a lot of activity in the post operative period or there is inadequate compression, and rarely happens when the Lockwood technique is used. It can easily be treated with a needle aspiration, but it is not unusual to have to do a series of aspirations spaced over a few days to take care of the problem.

Hematoma

A Hematoma is a collection of blood in the dead space. It usually needs to be evacuated because it can be painful, can lead to infection or cause excessive scarring. It is usually caused by a small blood vessel that opens up in the recovery period, and can happen up to a few days after surgery. Most of the time it can be evacuated with a needle, but sometimes it may need a small intervention in a procedure room.

Remedy: The best remedy against fluid collections is prevention. I am a firm believer in the right kind of compression garment with shoulder straps to keep the garment well placed. In addition, foam pads (Topifoam pads) over areas of potential fluid accumulation also help a lot.

DISCUSS POSSIBLE COMPLICATIONS BEFORE YOUR SURGERY

All in all, the Tummy Tuck is a very safe operation. However, you need to be aware of the risks and potential complications prior to any surgery. When you go into your pre-operative tummy tuck consultation be sure to ask your plastic surgeon about these possible complications and how he or she handles them when they occur. Most importantly, get a commitment that the surgeon will be available after surgery within a short time period should you experience any problems. I give all of my post op patients my cell phone number so I can communicate immediately if any problems or concerns arise. Be sure you know how to get answers to post op questions prior to your surgery.

By Dr. Ricardo L Rodriguez
Board Certified Plastic Surgeon
Baltimore, Maryland
Ricardo L Rodriguez on Google +

Posted in Body

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31 Comments

  • wrote
    September 4, 2014 at 12:25 am

    Thank u doc ……

  • wrote
    September 3, 2014 at 10:11 pm

    Ashwini:
    Your doctor is right in not offering to suture it. This will heal by packing over several weeks or a couple of months. That is the normal course. You will probably need a scar revision after that.
    But as far as more practical advice, you really need to rely on your surgeon or the Doctor who is seeing you in person.
    Hope this helps!

  • wrote
    September 3, 2014 at 10:07 pm

    Stephanie:
    Get another opinion from another plastic surgeon if the present one does not want to operate.
    Regardless, you may need to have to have a repeat procedure to remove the seroma cavity. And since it was cosmetic surgery, insurance may or may not cover it. That is why the Plastic Surgeon said you needed a referral from your primary care physician- that may help you get insurance coverage. But you may need to pay for it.

  • wrote
    September 2, 2014 at 1:29 am

    Hi,

    I under went abdominoplsty a month back my suture libe open up around approximately 10 cm s and has a yellow fluid discharge which is coming down (I hope) .my doc says it will settle down ..He says he won’t suture it . And asked me to discontinue compression garments . I am scared how long it takes for the wound to heal .can I wear pressure garments during thus time .plz guide me

    Ashwini

  • wrote
    August 30, 2014 at 9:44 pm

    Yes I have a question!! I had a tummy tuck on 3/12/13 it was done by a dr in florida & then I returned to NC right after I got home I started swelling ALOT so I contacted a local plastic surgeon who did scans ^ said I had an extreme amount of fluid collecting”seroma” so he drained me that day and got a littlle over 9 syringes full, after that I returned to him every other week ti have more drained and my incision looked like it was healing good ! I didnt see this dr for about. 3 WEEKS & noticed more fluid gathering and my incision drawing way up on one side and had so much fluid in the front pelvic area that I bent over n felt a pop like a bee sting looked a saw that a big part of the middle incision was hanging down & Very Painful, the dr drained this again to give me some relief and the fluid instead of coming out orange or red it looked like pickle juice or bright green urine!! Since this and so much pain iny abdomen and my incision which hurts now worse than right after surgery n still collecting fluid this plastic surgeon up here tells me that I need to get my family dr to refer me to a surgeon to put in a drain cause theres nothing normal about still developing seromas almost a year and 1/2 after tummy tuck!! IN SORRY THIS IS SO LONG I JUST WOULD LIKE TO HAVE YOUR OPINION ON WHAT YOU THINK ABOUT WHAT U HAVE TOLD YOU!!
    IN PAIN , DEFORMED & DESPERATE!! THANK YOU DR GOD BLESS!!

  • wrote
    July 13, 2014 at 2:57 pm

    Danielle:
    This is a problem you need to address with your surgeon, You have to let him know you are worried.
    What you have is called a “seroma” or fluid build up of serum. It is not dangerous by itself, but can be if it becomes infected.

  • wrote
    July 11, 2014 at 4:00 pm

    I had a hernia repair with tummytuck 1 month half later I have a large lump on right side , that has been asperited 3 times and drained.
    Please advise me what to donthe area hurt its swollen and it has heat in the area.what should I do

  • wrote
    May 6, 2013 at 8:30 pm

    Zinia:
    Not having done your surgery, there’s very little I can add.
    I would just suggest to ask your surgeon very detailed questions and ask to be examined carefully. Don’t take no for an answer.

  • wrote
    April 26, 2013 at 9:26 am

    Why do i feel like i have sticks inside of me that move when ever i move? i just had atummy tuck it really feels funny like theres something lose inside of me. I told the surgeon who did the procedure and she said she dont think i have anything to worry about it is very uncomfortable. any advice?

  • wrote
    September 4, 2012 at 9:26 pm

    Sammy:
    Since the other plastic surgeon has seen you he is the best person to handle the case from now on. He knows you, he has seen you in person.
    A Plastic Surgeon in the internet has very little to add compared to a guy who has seen yo in person and has examined you.

    For what its worth, compression garments really help to reduce and resolve scars.

  • wrote
    August 23, 2012 at 9:10 pm

    Greetings Dr Rodriguez,
    I had the mommy makeover TT, BA and lipo on flanks on 7/26, at 6 days post op I experienced heavy bleeding bulbs reached 75cc and 100cc. Four hrs later dizziness, cold sweats, pale, loss of air. I called PS but wasn’t avail and his nurse advise to bed rest, that it could be of too much activity. Which it wasn’t I was just walking more per the instructions. Next day on my post op appt Dr was not avail just nurse. She reassure me it was just swelling, not hematoma or seroma. Five days later Dr aspirates with syringe through drains some old blood. I get home same day and hit fever from 99-102 through out the day. Next day I go to ER where they performed all kids of tests for blood clots, I was tachichardiac, and my red blood cells dropped to 8 and white cells were at 10. They discharged me to go see my PS 2 days later when he removed drains thinking that was the cause of fever. Later that same day, fever continues, right numb leg and chills. Go back to ER and was hospitalized to treat infection for 5 days with 4 different types of antibiotics. Next day after my discharged PS opened incision to drain old blood, only about 100cc came out. Today 8/22/12 still in pain hematoma is causing pressure on my right leg; CT scan revelead it measures 13cm. hard spots and tender still. PS closed incision after second surgery. What are my options now, I have already paid another PS for second opinion and agreed that this should have been taken care right when bleed happened that at this point time will tell. Should I seek further help such as lymphatic massages? I don’t want this hematoma to turn into scar tissue if it doesn’t reabssorbs . Please advise. Thanks in advance.

  • wrote
    June 4, 2012 at 9:45 pm

    Liz:
    Most likely not. It probably is a little fluid or scar, but to really know, you should see your doctor.

  • wrote
    May 27, 2012 at 1:39 am

    Hi Dr. Ricardo
    I had a tt and a bb.on march 26, 2012 and today may, 26 2012i went to the gym and was doing the leg press and felt an uncomfortable lil pain in my stomach and i felt it and feels sore plus a little bump, could my sutrues have ripped and is that dangerous?

  • wrote
    May 19, 2012 at 11:44 am

    Jasmine:
    Sorry we did not answer before. How are you coming along?
    Just to let you know, with the repeat surgery you had it would be normal and expected to have a longer recovery period than normal.
    Just be sure to keep wearing compression, it is great for scar resolution and control of swelling.

  • wrote
    May 14, 2012 at 8:22 pm

    Hi Dr. Rodriguez,
    I had a tt on 4.16.12, had jp drain for 8 days (never measured more than 25cc in 24 hr period), 4 days after drain being pulled my PS had to aspirate 360cc from a seroma. Three days after that, PS aspirated 420cc of seroma. Four days after that, PS could only drain 40cc. He couldn’t pull more fluid. Went into surgery again on 5.9.12 to drain seroma and reinsert drain (this time a Davol drain). He discovered a hematoma which he also excised. I haven’t emptied my drain since first post-op appt on 5.11.12. It is now 5.14.12 and there is maybe 100cc. I figure at my next post-op appt (5.15.12) my PS will pull the drain b/c of low output. Is this wise? Should I keep it longer just in case? I feel compressed enough, but I want the PS and nurse to help me into a smaller garment just in case (I have a garment that has shoulder straps).

    Also…should I still be a little tender where the hematoma was excised?? Or should I not feel anything? Can hematomas recur if they are excised?

    Thank you.

  • wrote
    March 16, 2012 at 1:58 pm

    Ethel:
    I have answered your posts in the other places you posted questions. If you think we can help you contact us at kelly@cosmeticsurg.net
    Hope this helps!

  • wrote
    March 16, 2012 at 10:39 am

    i have had smart lipo 8 months ago. have had burning, and pain every since. i thought i may have an ucler but was check. no i dont . the burning gets so bad some times it wakes me up. if i eat more than i should it feels like i am riping apart… whats the problem ????

  • wrote
    January 19, 2012 at 6:51 pm

    June:
    Could be any number of things. The most common could be a retained suture.
    You need to talk to your surgeon or a Plastic Surgeon where you live who can examine you.

  • wrote
    January 18, 2012 at 11:55 pm

    I had a tummy tuck in 2009 but in 2012 the insion site started to re open what’s going on?

  • wrote
    January 8, 2012 at 3:42 pm

    Lu:
    Hope Jan 6 went well.
    If you check out the girl on this blogpost she had a repair of the rectus diastasis going thru the umbilicus.
    This procedure can be very useful for bodybuilders that had separated muscles after pregnancy without too much skin excess. That way they have NO SCAR except for the small scar around the belly button.
    BTW, saw your pictures, and you are fantastic. You should be very proud of your accomplishments, with a family and profession in addition! Super Mom indeed!

  • wrote
    December 26, 2011 at 3:50 pm

    Dr. Rodriguez thank you again for all your help.

    It’s funny you should say that because I already mentioned you to a few friends of mine that are fellow bodybuilding competitors. I’m sure you’ll be hearing from a few of them soon as they have a lot of questions before they dive in… Most of them are for breast augmentation and 2 regarding stretch marks along their thighs. I compete in the bikini as well as figure bodybuilding categories – this past october I qualified for the nationals in Canada. I will be competing in June 2012 at that level. That’s one of the reasons why I wanted to get my tummy tuck done. Bodybuilding and competing is really a hobby. My profession is Creative Director & Marketing Consultant in the field of advertising. Now that my husband and I have our two kids and no plans of having anymore, it was time to hit the stage and compete… but I did need to get my tummy taken care of. Both kids were 9 pounders and I’m really small so you can imagine the shape my tummy was in. After I had my daughter I went up to 165 lbs – my pre-baby weight was 120 lbs. So I decided to take a year to get rid of of the body fat and get back in shape. At my last show I was 117lbs and my transformation from the day I started has been amazing. Through clean eating, a strategic workout regimen and a lot of dedication even on days when I didn’t feel like it, I managed to get back into shape. I’m hoping I can compete this coming June. Hopefully this recovery doesn’t take more than it should so I can get back to my 300 plus lb leg presses etc LOL! I need at least 5 months to gain some more muscle and then lean out. But here I am December 26th 5 weeks post surgery and I can tell I still have fluids in my abdomen and feeling very tights on the lower part of my tummy —- I’m hoping he drains the remainder on Jan 6th even though he said last time there was not much in there…. Last time I asked him if I was on track to be released fully to exercise — he first said yes… and then I told him “By the way doc, you do realize I leg press 300-400 lbs and bench press 80-100 lbs right? because when you release me that’s the training I’ll be going back to..” He then paused and said wow I can’t leg press that much. Mrs. Diaz you’ll have to wait until I’m comfortable releasing you to do that.” —- Which indicates to me that he may not release me as scheduled…. Oh well — no turning back now. Recovery comes first. Thanks again Dr. Rodriguez. I will spread the word of your site to my friends. Check out this link of my competition pics on my facebook: https://www.facebook.com/media/set/?set=a.10150324540561643.346131.690686642&type=1&l=1b1619c831

  • wrote
    December 25, 2011 at 11:50 am

    Lu:
    Closing it now would be a mistake. It needs to drain.
    And yes, you need to see him again soon.
    He is handling it right.
    BTW Lu, if you appreciate what I have done just spread the word about my site to other people online and to your friends.
    Merry Christmas!

  • wrote
    December 20, 2011 at 11:12 am

    Hello again Dr. Rodriguez. I visited my PS yesterday and he extracted 3 more syringes of old blood. My tummy looks flat now but it still feels tight. I noticed redness along one spot on my incision. I asked him about it and he put me back on antibiotics for a week. I woke up this morning to find yellowish liquid coming out of one small spot. I’m hoping I can see him again today. I spoke to his nurse and she said it was probably the infection coming out and to just wipe the area and keep it dry. I’m hoping I can see him so he can have a look at it. I’m wondering if he should be closing that particular spot later on by stitching it… it’s only about 3 cm. I’ll let you know what happens. Thank you for all your help.

  • wrote
    December 20, 2011 at 9:27 am

    Lu:
    You need to get on the phone and call your Doctor and you need to talk to see him. Tell him you still have fluid and you want it aspirated. You do not want to wait until Jan 6 to see him.
    You also need to be wearing compression 24/7.
    Let me know what happens after you see him.

  • wrote
    December 20, 2011 at 12:26 am

    Thank you Doctor Rodriguez. To be honest with you, I failed myself by not digging deeper before my surgery. I’ve read a lot about the Lockwood technique and kick myself for not getting a surgeon that uses it. I would recommend to anyone that’s thinking about getting a TT to ensure they get a physician that practices it. I’m going to see my PS January 6th – hopefully I don’t need many more sessions. I’m hoping once the swelling goes down I will be able to stand up straight like before the surgery. My back is killing me and my PS told me to just stand up straight but I feel like my obliques are going to rip. I’m considering Lymphatic massages and stretching. I just don’t want to do any damage inside. Is there anything you can recommend that I could do at home to help? It’s been 4 weeks today since my surgery. Thanks again Dr. Rodriguez

  • wrote
    December 19, 2011 at 10:21 pm

    Lu:
    It seems he is handling it appropriately. It may take several sessions to drain the hematoma completely. I would continue to wear a compression girdle continuously (day and night) until the problem is resolved.
    I have not had this problem since I started using the Lockwood technique for abdominoplasty.

  • wrote
    December 16, 2011 at 6:58 pm

    Like all surgeries, there are dangers of complication afterwards even thought surgeons do their best in the OR to prevent this. Still, it is difficult to predict how a human’s body will react to certain types of surgeries, even when all the possibilities have been explored first.

  • wrote
    December 16, 2011 at 11:57 am

    Dr. Rodriguez –

    Thank you for post above. I’ve been trying to find out if extracting hematoma fluids after a tummy tuck may require a few visits. I recently had a tummy tuck. I have a hematoma. My doctor told me to wait a few days for the liquid to soften up. I’ve been to see him 3 times now and the first time he extracted a little bit of fluids. The other two times he’s extracted a couple of larger syringes worth. My abdomen looks smaller but it seems like the fluids move down on the abdomen. He’s having me come in again… I’m wondering up to how many visits it may take to extract all fluids and is that safe… I’m worried the hematoma will get infected. I had surgery November 22 2011 and today is December 16th. So I’m 3 weeks post-op. Is there any information or recommendation you can give me regarding this? I can’t seem to find information regarding how “normal” it is for various sessions to be required to extract a hematoma via needle… your help would be greatly greatly appreciated. Thank you.

  • wrote
    December 2, 2011 at 7:44 pm

    I am so scared to any complications. I want a healthy body that’s why I manage to eat healthy foods and do daily exercises. Anyway, thanks for sharing those info above I have learned enough about the subject.

  • wrote
    December 1, 2011 at 7:35 pm

    Yolanda:
    You should be getting an email from Kelly pretty soon.
    As far as where the fat comes from it really depends on the individual patient. On some cases the patient benefits more from a tummy tuck, on others, liposuction only will do.
    If you have a lot of stretch marks and a split muscle from pregnancy then a tummy tuck may be indicated.
    I’m looking forward to seeing you!

  • wrote
    November 26, 2011 at 4:51 pm

    When getting a Brazilian Butt Lift i understand they take fat from one area and then purify it and then its distributed accordingly to the buttocks. However, if fat is taken from back all the way up to bra line and love handles, plus upper and lower abs can this fat be taken by liposuction? or do u have to get a tummy tuck? and actually be cut and have that lower abdominal scar? what is better? i left a vm message and am interested in procedure please contact me thanks!!