Seromas are bound to be an issue for some, especially at a busy gynecomastia practice that treats patients from all over the world. The big questions that come up are: What are the consequences of a seroma? And how do you treat it, especially if you are from out of town?
A seroma is a collection of watery fluid in the area of the chest that is treated by your surgeon to remove the gynecomastia tissue and contour the chest fat. The true frequency of this problem is unknown, but in my personal experience with thousands of cases, it is the most common problem that I have to manage, occurring in 15% of patients or more. Seroma formation is not uncommon after female breast surgery, and perhaps for similar reasons, it is also seen in men who are treated for gynecomastia. The causes are not fully understood, but I suspect it has something to do with movement of the chest muscle after treatment.
A seroma can be recognized as a swelling in the chest that hadn’t been there before or hadn’t been well localized to a specific area. It feels like a water balloon or a “fluid wave” in some cases. It may or may not be associated with bruising and varies in size, though in most cases it’s no larger than a walnut. Seromas are associated with excess fluid intake after surgery, and therefore may resolve on their own with little risk of infection.
They typically do not cause pain, but they may be tender in some patients. Induration (firmness) of the surrounding tissues and redness of the skin is common. Some patients are simply more susceptible to developing seromas for unknown reasons. After the gynecomastia mass is removed, what’s left is an empty cavity. The body is prone to filling this dead space with bodily fluids. To prevent fluid accumulation, I use surgical drains and specific techniques, like my quilting sutures, to eliminate dead space.
A seroma can alter the healing process in multiple ways, which could negatively affect the result of your gynecomastia contouring. First, the fluid can cause inflammation and hardening of the tissues, resulting in the formation of creases and folds. If the fluid becomes infected, an abscess (collection of pus under the skin) can form, often requiring drainage and antibiotics. If a seroma is present for many weeks, it will commonly form a wall of scar tissue around itself that then is appreciated as a mass or “recurrence” of the gynecomastia. This is simply scar tissue but may require removal as a secondary procedure.
The best way to prevent seromas is to find a surgeon uses the best techniques, like the aforementioned drains or sutures, and makes the effort to minimize the potential for seroma formation. To limit swelling after treatment, compression is also beneficial. The use of diuretics (drugs that increase water loss from the body) to prevent seromas is unproven and not advised. Drinking large amounts of fluid after treatment does not increase the speed of healing. On the contrary, it will only lead to more swelling and increase the potential for seroma formation.
Seromas that appear within one month of surgery can generally be managed with simple aspiration techniques. This means that a syringe with a small needle is inserted into the area of the body containing the seroma to withdraw the fluid. Several treatments may be necessary until the seroma is completely gone. The frequency of treatment depends on how quickly the fluid fills back and becomes noticeable. Typically, several treatments over a month would suffice. In more difficult and stubborn cases, your surgeon may need to perform a drainage procedure. Beyond a month, older seromas that form scar tissue are best treated by excision.
From a plastic surgeon’s standpoint, removing a seroma is a minor issue. Unfortunately, if you are from out of town and you are seeing a doctor with different training and experience, he or she may make things sound more complicated than necessary. We recommend that our patients seek out someone who is comfortable inserting a needle into the area and removing fluid. This can (and should be) any medical doctor. There are no critical anatomical regions in the chest area, and inserting a needle under the skin will not adversely affect your result. Unfortunately, many doctors are reluctant to treat even minor issues that have arisen from the hands of another doctor, often from a common fear of damaging the work done. You will have to deal with this mentality.
Most seromas will be found in the area close to the nipple-areola complex, as this is the primary location of gynecomastia tissue that is treated with liposuction and/or direct tissue removal. This will leave a “space” for fluid to collect. A common patient complaint would be that one nipple is flat while the other is still puffy. “Did you leave some tissue, doctor?”
When dealing with seromas, patience is a virtue. They happen, and they probably often happen because patients drink too many fluids after treatment, including alcohol. I understand why this could be frustrating, time consuming and even costly. But in this case, the benefits of preventing seroma formation outweigh the potential costs of limiting fluid intake. If you are a local patient, I could simply take care of it in my office. If you are from out of town, it can be challenging engaging with the health care system to deal with a simple issue. Whether or not insurance covers the cost of seroma treatment is very much dependent on your specific provider, to whom you should direct your questions regarding cost.
In summary, these points need to be reemphasized:
- Seromas do not harm your health.
- They may resolve on their own without treatment.
- Limiting fluid intake and wearing compression garments can help seromas go away.
- Seromas are commonly treated by aspirating the fluid. Several aspirations may be required.
- Seromas lasting more than six weeks are uncommon, but all seromas eventually go away.
- Seromas can affect the healing process, leaving contour irregularities or a small mass.
- Patience is a virtue that helps those who develop a seroma.
If my staff or I have suggested you read this information about seromas, I’m sorry for your troubles but I appreciate your understanding. We will all work with you to resolve the issue so that you can move on to enjoying the results of your gynecomastia treatment fully!