Seroma: Identifying and Treating a Surgery Side Effect

Also, What Makes Them Come Back?

Medically reviewed by David Hampton, MDMedically reviewed by David Hampton, MD

A seroma is a common postsurgical complication in which fluid accumulates under the skin at the surgical site. Often, patients notice a swollen, soft, or squishy area forming a few days after surgery. This buildup of seroma fluid can cause discomfort and sometimes lead to more serious issues if left untreated.

This article covers the the causes, symptoms, and treatment options for seromas, along with when to seek medical advice.

Seroma After Different Surgeries

Seromas can occur after various surgical procedures, including:

• Breast surgery, such as a lumpectomy or mastectomy

• Hernia repair

• Abdominal surgery

• Tummy tucks

• C-sections (surgical deliveries)

• Removal of thyroid tumors

• Liposuction

Seromas may appear seven to 10 days after surgery and after removing drainage tubes. Most of the time, seromas absorb back into the body in about 30 days, but sometimes they take up to one year to fully reabsorb.

Causes of Seromas

The exact reasons seromas develop are not fully understood, but some factors are suspected to increase the risk. Surgeries involving significant tissue manipulation or removal increase the risk of seroma formation, such as breast surgeries and large-volume liposuctions. Early or excessive movement postsurgery can disrupt healing and promote fluid buildding to a seroma.

Seroma vs. Cyst Symptoms: How to Tell Them Apart

While both seromas and cysts can present as lumps under the skin, there are distinct differences between the two.

Seroma

A seroma typically forms soon after surgery and is filled with serous fluid (the clear portion of blood), along with lymphatic fluid.

Seromas typically appear as a lump or swelling under the skin close to the surgical incision, and these areas can be tender and sensitive when touched. If you think you might have a seroma, you can gently press on one side of the swollen area and observe for a wavelike motion under the skin, which suggests the presence of fluid.

Cyst

A cyst is a closed sac containing fluid, air, pus, or other substances and may not necessarily be related to a recent surgical procedure. Cysts are round lumps just beneath the skin. They sometimes have a small, dark spot in the middle and can grow from 1-2 centimeters to several centimeters. They are slow-growing.

Two types of cysts that commonly form under the skin are epidermoid and sebaceous cysts, both appearing as smooth, flesh-colored, or whitish-yellow lumps. Epidermoid cysts develop from surface skin cells that move deeper into the skin, while sebaceous cysts form when oily gland secretions become trapped, creating a pouch filled with a thick substance.

Common locations for skin cysts include:

• Head

• Face

• Neck

• Chest

• Back

• Scrotum or vagina

When to Contact a Healthcare Provider

It's crucial to monitor the seroma for signs of infection or complications. Contact your healthcare provider if you experience:

• An opening that forms on your suture line

• White or blood discharge

• Increased redness, warmth, or swelling

• Fever or chills

• Rapid growth or hardening of the seroma

It is uncommon for seromas to become infected; however, it can happen. Contact your provider right away if you feel ill, have a fever, or have any symptoms of infection, such as pain or oozing at the site. Antibiotics are typically prescribed for the infection.

Treatments to Reabsorb Seroma Fluid

Seromas can vary in severity and may sometimes resolve on their own. Small seromas that do not hinder the healing process typically do not require medical intervention as the body can naturally absorb the fluid over time. However, for larger or problematic seromas, various treatments can facilitate fluid reabsorption and alleviate discomfort.

For minor seromas, patients can take several self-care measures to support healing and fluid reabsorption:

• Proper drainage maintenance: If you have postoperative drains, ensure that the tubes are not obstructed to allow for effective drainage.

• Compression garments: Wearing compression garments as advised by your surgeon can help reduce fluid build-up and promote faster healing.

• Over-the-counter (OTC) pain medication: OTC pain relievers can help manage swelling and discomfort.

• Warm compresses: Applying a warm compress to the affected area can encourage fluid drainage and provide relief.

Needle Aspiration

When a seroma is more severe, needle aspiration might be necessary. This procedure involves using a needle to withdraw the fluid from the seroma. Needle aspiration is recommended in the following cases:

• Large fluid accumulations that are unlikely to reabsorb naturally require intervention to prevent complications.

• If the seroma impairs your mobility, draining the fluid can help restore movement.

• Seromas that put pressure on sutures can affect surgical outcomes. Aspiration reduces this strain.

• Seromas that become infected need to be drained to reduce the risk of further complications.

Recurrence and Minor Surgical Procedures

In some cases, seromas may refill after needle aspiration. Repeated aspirations can increase the risk of infection, so your surgeon may recommend a minor surgical procedure to remove the seroma more definitively. This approach aims to reduce the risk of infection and ensure a more permanent solution.

Having Repeat Drains and Procedures

For some patients, seromas may recur despite initial treatment. This can be distressing and may require repeated needle aspirations or drain placements. Following your healthcare provider's advice on managing and preventing recurrent seromas is essential. Strategies to prevent seroma formation include:

• Using suction drains to help drain liquid from the site

• Limiting physical activity that may strain the surgical area

• Using compression garments as recommended

• Following postoperative care instructions meticulously

Sclerotherapy

To treat stubborn seromas, a healthcare provider might inject a substance into the area to irritate it and help it heal by closing the empty space. This procedure is known as sclerotherapy. If the seroma keeps coming back, the surgeon may need to put in a new drainage tube or, in rare cases, perform surgery to drain the fluid.

How Long Does Seroma Take to Treat?

The time it takes to treat a seroma varies depending on the size and persistence of the fluid accumulation. In many cases, seromas resolve within a few weeks with appropriate management. However, some seromas may take several months to a year to fully reabsorb.

Summary

Seromas are a common post-surgical complication characterized by fluid accumulation under the skin at the surgical site. Identifying the symptoms early and seeking appropriate treatment can facilitate reabsorption and prevent complications.

Treatments include compression garments, needle aspiration, drain placement, and sclerotherapy. Recurrent seromas may require repeated interventions, and following postoperative care instructions is crucial to minimize the risk of recurrence. Understanding the causes, symptoms, and treatment options for seromas can help patients achieve the best possible outcome in their recovery.

Read the original article on Verywell Health.