When tissues of the body are disrupted-- from trauma, surgery, of other cause-- the body initiates a healing process that involves a complex cascade of steps that help to close or heal a wound. There is a plethora of substances, including chemical messengers, hormones, proteins, and more, that are essential to the body’s ability to restore form and function.
In cases of surgery, where tissue is removed, a fluid collection, a seroma, may form in the space that is now devoid of tissue. A seroma may appear as a swelling beneath the skin, and is typically composed of a clear, yellowish fluid that is filtered from the blood.
Predisposing factors may include trauma and surgery. However, the true cause of seroma formation is not well known. The consensus among surgeons is that seroma formation is a result of a multitude of factors.
Any operation where tissue has been significantly disrupted or removed may lead to the development of a seroma. In addition, a study by V. Srivastava et all suggests that other causative factors include the surgical technique, extent of dissection and the surgical devices used on the tissues during the operation.
Seroma formation is not always problematic, as the fluid collection may sometimes resolve on its own. Nevertheless, in plastic surgery, the surgical procedures that are most often associated with seroma formation include but are not limited to: mastectomy, breast augmentation (breast implant surgery), thigh lift, buttock lift, and abdominoplasty (“tummy tuck”).
BIA-ALCL is a type of lymphoma or cancer of the immune system associated with breast implants. If a woman develops this condition, the cancerous cells are often found in the scar tissue or fluid (seroma) at the surgical area.
While seromas may cause some discomfort, they are not typically painful.
Sometimes, depending on a number of factors (surgical technique, extent of dissection, use of devices, size or volume of the fluid collection, etc.), a seroma may resolve over time as the body slowly and steadily absorbs the excess fluid collected in at the surgical site. This may take weeks to months.
The management of a post-operative seroma may be surgical and/or non-operative.
Minor seromas of a small size or volume may not require intervention as they may be reabsorbed by the body.
Larger fluid collections that are painful or otherwise problematic (become infected or interfere with healing, etc.) require additional treatment.
Non-surgical options for management include the application of compression bandages and manual lymphatic drainage.
Surgical options include drainage, via a needle inserted through the skin or open drainage via a surgical incision.
The development of a seroma should prompt consultation and a visit to your surgeon, who will direct you to the most appropriate treatment after examining the area of concern.
Potential complications that may develop from a seroma include but are not limited to: infection, abscess formation, abnormal scar formation, loss of tissue, pressure on surrounding tissues, and prevention of wound healing. Prevention, indeed, is the best medicine.
Since the specific cause of seroma formation is not known, there is a scientific hypothesis that a multitude of factors may contribute to the development of a seroma after surgery.
Of the “patient-related” risk factors, what the patient may control are body weight, high blood pressure, and smoking. As such, in general, this emphasizes the concept of holistic well-being, especially before surgery. Specifically, what may help in the prevention of some post-surgical complications is that the prospective operative patient prepares for surgery holistically, addressing a number of dimensions of wellness, before surgery, so that the patient is in her best possible condition—inside and out.
After surgery, there is a particular type of massage that may help reduce the chance of seroma formation. Manual lymphatic drainage, MLD, is a specific kind of massage where the therapist uses light pressure combined with mild or soft pumping actions to help increase the efficiency of flow of the lymphatic system, which is the circulatory system of the body that helps to eliminate excess fluid. Before surgery, MLD may help decrease the chance that a seroma will form. After surgery, the massage technique may not only reduce fluid buildup but also discomfort, swelling and abnormal scar formation.
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