You Have a Seroma After Surgery — What Should You Do?

First things first: always, always, always call your surgeon. Your surgeon should be helping you navigate this. As a patient, you should never be navigating a surgical complication by yourself — and that's true even if your surgeon is far away or in another country. Your first call should be to them.

A seroma is simply a fluid collection in the area of the surgery. They're not inherently dangerous, and this is not an emergency.

A routine seroma is not something that should send you to urgent care or the emergency room. If you go to these places, it's unlikely that anyone will drain it for you — so it's a big, expensive waste of your time. When I've been called from the emergency room about a patient with a seroma, my response is: I'll see them tomorrow in the office.

The majority of seroma drainages can be done right in the office — often under ultrasound guidance, and sometimes we don't even need ultrasound. We numb the area, withdraw the fluid, and the area should go flat.

Some surgeons will send you to interventional radiology instead. That's typically because they want a small drain placed at the same time. This approach is for larger seromas with a high chance of recurrence — the drain allows continuous drainage until it peters out, then we pull the drain.

It can be problematic to leave a seroma untreated for a long time:

• It can develop a capsule around it, just like an implant does. Once there's a capsule, it's unlikely to go away without surgical intervention or sclerosis.
• It can distort your tissue and make things look uneven. If you've had a cosmetic procedure, a chronic seroma can permanently alter your outcome.

This is why you should alert your surgeon right away if you're concerned.

If it's small and encapsulated: We can often drain the fluid and use a sclerosing agent to irritate the walls of the seroma cavity. This causes it to collapse flat and hopefully not come back — usually done in the office.

If it's larger or has failed other methods: We may need to go to the operating room to remove the capsule and start over.

The one instance that is an emergency is when a seroma becomes infected. An infected seroma needs to be:

• Drained immediately
• Treated with antibiotics
• Often managed with a drain

It can be challenging as a patient to know whether a seroma is infected, because seromas — especially with dependent edema — can cause redness in the lower portion that looks concerning but is actually normal. Again, your surgeon is your best resource to figure this out.

• Seromas can almost always be treated as an outpatient
• It is not an emergency for most patients
• Your first call is always to the surgeon who did your operation
• Don't wait too long — chronic seromas can develop capsules and affect your results