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A tummy tuck, or abdominoplasty, is one of the most common body contouring procedures. It is unrivaled for what it can do to the waistline when there is loose skin and excess fat for which there is no other satisfactory solution. Despite the success of the procedure, it is not complication free. The most common postoperative problem in tummy tucks, in my experience, has been that of fluid collections.

Known as seromas, these fluid collections accumulate in a characteristic time period of two to three weeks after surgery. Even though drains are placed in most tummy tucks and are used up to 10 days after surgery, seromas can still develop later. Seromas occur due to internal unhealed surfaces that express mainly lymphatic fluid somewhat like that of a brushburn. Compression garments and keeping one from getting too active helps but about a third of patients will still get some amount of seroma fluid in the first month after surgery.

While not one dies so to speak from a seroma, it is an inconvenience for the patient and most certainly can be uncomfortable. They will require intermittent drainage in the office and doing it just once rarely solves it. My usual experience in tummy tuck seromas is that once they develop, it will take a month of abdominal tapping before the fluid no longer accumulates. (as the internal surfaces have healed and stopped leaking fluid)

Several techniques have been developed in the past few years to decrease these abdominal seroma problems. One such method is that of quilting sutures. These sutures are done by sewing together the underside of the skin flap to the fascia of the abdominal muscles just prior to skin closure. It can be done using individual sutures at multiple points or using a running barbed suture which is placed in a series of rows. This method does work for seroma reduction but is tedious and time consuming which does add to the cost of the operation. There is also the possibility that the quilting points may cause some visible skin indentations where the sutures are placed.

Another technique for seroma reduction is in how the tummy tuck is performed. Rather than wide undermining of the upper abdominal skin flap the whole way up to the rib margins, a combination of liposuction and more limited skin flap raising is done. This preserves more attachments in the upper half of the abdomen and therefore makes less non-adherent tissue surfaces that have to heal…what we would call in plastic surgery less ‘dead space’. The sewing of the abdominal muscles (rectus muscle fascial plication) is done through a narrow tunnel up to the xiphoid process rather than the full raising of the upper abdominal skin flap. This technique requires a liberal use of liposuction throughout the upper abdomen with less tissue undermining. This not only preserves tissue attachments but also keeps a better blood supply into the skin flap for incisional healing.

While I like the quilting suture method for seroma reduction, the concept of ‘don’t detach as much to start with’ seems even better. While it may not be ideal for some tummy tucks, I use the ‘lipoabdominoplasty’ method more and more. As has been demonstrated by many other plastic surgeons around the world, the postoperative incidence of seroma is definitely less.

Dr. Barry Eppley

Indianapolis, Indiana

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