Why Can't My Surgeon Drain My Seroma?

If you know there's fluid in a seroma, how come your surgeon sometimes can't get it out? This is a really good question — and I know it sounds like it should be simple with a collection that large, but there are a few different reasons why it can be challenging.

If you look at the dimensions of a typical seroma, it may be relatively wide but not very tall. Depending on how thick your tissue is, getting into that small space can be difficult.

We'll often have patients stand up so gravity helps — all the fluid comes down to expand the lower portion of the cavity, which can make it a little easier to access.

It's important to recognize that seroma fluid isn't always very thin. Sometimes it's quite thick, and it can even be gelatinous — very difficult to get through a needle, even a very big one. That often limits our ability to withdraw fluid or fully drain the seroma.

Sometimes there's something called loculations throughout the seroma. It's not just one big open cavity — there can be little walls throughout it that partition off small pockets of fluid. It's impossible to get through all of the different walls with a single needle pass.

Ultrasound can certainly help, because you can sometimes visualize those walls. But loculations are another reason why draining a seroma can be more challenging than expected.

I know it sounds super simple, but draining a seroma can actually be really challenging — depending on where it is, its shape, the fluid quality, and the presence of loculations.