Saturday, September 20, 2008

What is a Pseudo-bursa?

Recently I have had a few questions about bulging or fullness following tummy tuck. While there are a handful of reasons for fullness to be noticed some time following the tummy tuck procedure I think the presence of pseudobursa is often under reported or underdiagnosed.

So what is a pseudobursa?
Simply put a pseudobursa is a pocket of extra thick scar tissue. Remember those drains that you had after the tummy tuck? They were necessary to prevent a seroma, or collection of "healing" fluid. Despite the use of drains, however, seroma can still ocurr. It is not hard to imagine that some seroma fluid accumulates after the drains are removed. Of course, the majority of the time the body keeps up with absorption of the seroma fluid and any extra fluid that may be under the abdominal soft-tissue is not noticed. The body naturally wants to isolate any free fluid between the abdominal soft tissue and the abdominal wall. The body knows that it does not belong there so it sends in cells to create scar tissue around the fluid. This scar tissue surrounding a fluid pocket is called a pseudobursa. If the wall of the pseudobursa is thin enough then they usually go undetected. Occasionaly a previously undetectable pseudobursa gets infected. When this ocurrs usually there is some tunneling and drainage at the nearest incision, either the lower incision in the midline or the belly button scar. If the pseudobursa contains a lot of fluid or the scar tissue is very thick it can be noticeable as a bulge or fullness.
The most common areas for pseudobursa formation is just above the waistline incision in the middle. This is the most gravity dependant area so it is naturally the most likely area for pseudobursa formation. Pseudobursa can also be seen just above the belly button. The presence of the belly button stalk and the surrounding tissue can form an area for a seroma to accumulate and for a pseudobursa to form.

How do you treat pseudobursa?
Although the pseudobursa can be injected with medicine to scar the two parts together and reduce the overall size, this is usually not that effective. If the pseudobursa is detected either by the development of infection or because it can be felt or seen as a bulge or fullness then it should be removed. The prior incision scar must be used to access the pseudobursa. The scar tissue is then removed, sutures are placed to obliterate the space where the pseudobursa was located, and drains as well as an abdominal binder are used similar to the original tummy tuck procedure. The recovery process is usually much easier than the original tummy tuck procedure with the exception of the drains and the abdominal binder.

Below is a photo of a pseudobursa excision.  Extra skin and soft tissue with the underying pseudobursa was removed.  When present on top of the abdominal wall the size of the pseudobursa is actually large and more spread out.  Once it is detached from the surrounding tissue it shrinks up.  This contractile property is likely related to some of the symptoms patients experience when a pseudobursa is present.




Feel free to ask any questions that I may not have covered. Look for an extended tummy tuck post next.

All the best,

Dr. Remus Repta
Phoenix/Scottsdale, AZ

128 comments :

Anonymous said...

Dr. Repta
I recently had PB evacuated, but it was done with liposuction equipment by PS. So, I can't be sure if the entire PB were removed. What happen if there are still remaining PB? Will the body rid this scar on it's own? Will the scar prevent the skin to reattach to muscle? Will seroma develop again because of the remaining PB?

Plastic said...

Dear Anonymous,

Pseudobursa becomes an issue when it presents as fullness, contour irregularity, or becomes infected. Not all pseudobursa are created equal,..some are thicker than others. Liposuction may help in certain cases by providing new fresh surface for healing to occur. It will unlikely remove much of the pseudobursa but in providing new fresh surface this can help the two sides of the PS "spot-weld" to each other. If the liposuction is not successful in eliminating the signs of the pseudobursa...that is you can still tell it is there, the next step would be to remove either to top layer or both the top and bottom layer of the pseudobursa. This will require a drain and wearing an abdominal binder for about 4 weeks.

All the best,

Dr. Repta

Anonymous said...

I had a tummy tuck in January 2009.
2 weeks post op I had a bulge above my belly button that was very full and uncomfortable. My surgeon was able to aspirate 50cc's from it with a suringe.Now the buldge is still very noticeable, hard and painful. Not much fluid anymore. The surgeon has named my condition a pseudo bursa and needs to revisit the area surgically in order to correct it. My question is: What are the chances of this Pseudo bursa coming back once it is stripped surgically?

Plastic said...

How far out from surgery are you? The first course of action is to draw fluid daily or frequently for a week or two while wearing the abdominal binder very tightly day and night. If this does not correct the problem then surgery is the answer. The key to success is a drain and day and night abd binder worn very tightly. Not a 100% chance of success but ends up fixing the problem most of the time. Other small techniques can be used to reduce the chance of recurrence but removing the scar tissue, drain, and binder are 99% of it.

All the best,

Dr. Repta

Anonymous said...

Dr. Repta,
I underwent a smart lipo procedure on my arms about a year ago. As a result I had a very small lump under one of my arms. Recently, the lump has become tender to the touch, fells warm, and it creates kind of a burning/ itching sensation. Also, it is infalammated and has enlarged. Could this be a result of the lipo surgery or do you think this is could be a separate issue?

Plastic said...

Did you have traditional liposuction after smart (laser) lipo to remove the fat that was liquefied? Is the skin overlying the bump red? It would be hard to imagine an infection resulting from any lipo procedure one year after. I would call the plastic surgeon and have him/her take a look at it since it is hard to diagnose the problem without examining it this far out from surgery.

All the best

Anonymous said...

Dear Dr. Repta,

I am 10 months post op from a tummy tuck. I had my first tummy tuck 14 yrs ago with no problems. I am a slim 55 yr old woman, so the second tummy tuck was really to remove some excess fat around the belt line and retighten the muscles.

I now have a huge bursa that extends from just above the belly button to down past the ovaries. It looks like a giant tumor. It is hard and hurts. At first the surgeon told me that I was not healing well because I am too active. He tried draining it often, I have worn a binder for 10 months, I have not exercised, lifted luggage or enjoyed outdoor activities with my family.

Two months ago after I became became frustrated that the condition was not getting better, but in fact worse, he tried twice to drain it and then flood it with highly concentrated saline. I had to lie in bed both times for 3 days, but it did not work.

Now he says that the only solution is to have another complete tummy tuck at my sole expense. I can't believe what a mess this has become and the numerous hours of time (lymphatic massages, binders, time off work) that this has caused. I could send you a photo and you would be completely grossed out.

I believe my surgeon is very qualified, but did he just not remove ALL the scar tissue from the 1st c-section when he was in there ? Could the same thing happen with a the next surgery?
I don't know what to do... But I certainly can't live like this for the rest of my life.

Have you ever seen a case like mine? I live in San Diego. Do you do second opinions?

Thanks, JS

Plastic said...

Hello JS,

I am sorry to hear you have been having a hard time with the recovery and attempts at correcting the issues.

As you may know the reason we use drains and abd binders after a tummy tuck is in part to prevent excess scar tissue and pseudobursa. If fluid if noticed after the drain is removed several visits per week for aspirations and agressive abdominal binder use is recommended to prevent a pseudobursa from forming. Once a pseudobursa has formed the options for treating it diminish. In our book Atlas of Abdominoplasty we cover all of the modalities of treating it non-surgically including injecting solution to try to get it to scar down, however, in reality those methods are mentioned only to be complete since most pseudobursa require formal surgery to elimintate effectively.

Surgically, with regards to pseudobursa, more is better. That is, it is far better to error on the side of being too thorough rather than not thorough enough. I think the most common mistake is to wait too long and when surgery is performed to do too little. The entire abdominal soft-tissue apron should be re-elevated, all of pseudobursa removed (at minimum the anterior or front wall), all of the non-dissolvable suture material present, ample drain use, and very diligent abdominal binder use. The more complete the surgery the less the chance for recurrence.

Hope this helps. Just remember that solutions exist and the problem can be taken care of with the right planning and understanding.

I am in Phoenix, AZ if you should need my advice/help.

All the best,

Dr. Repta

Anonymous said...

Dr Repta,

THANK YOU for this post! I've been looking all around the internet for help with my problem, and I'm wondering if this is it? Brief synopsis:

I'm 33 years old, male, and lost nearly 150 pounds through diet and exercise 10 years ago, but obviously still had the extra skin, so finally I decided to get a tummy tuck in August '09. My PS said he likely wouldn't need to do muscle repair, but when i woke up he told me he had to. I had the seroma complication for weeks afterwards. My PS had to aspirate me 3 times, taking out a total of about 1300cc's. Each time though he seemed really reluctant to do it for some reason. Finally when it came back only a "little", he said i should simply let the body reabsorb what was there.

By late October it felt mostly solid down there (no more waterbed-ing), but i still felt some awkward tightness in the lower abdomen. Then one night shortly before Christmas, i was stretching my back a little - tummy forward, back in - when i felt something "happen" in the area right around the belly button. Not really pain, but like something gave or moved. Now since that time, I've had a very, very uncomfortable tightness horizontally right behind the belly button - like i've just eaten a huge meal and have my belt on too tight, 24/7, constantly.

So now it's late Jan, almost 5 months after the procedure, and I'm wondering - do you think this might be a pseudobursa? I've been massaging the area like crazy and doing stretching as per my physical therapist, who i've been seeing for almost a month now because of this condition. I've been panicking a bit b/c I thought this could be a structural problem with muscles in my abdominal wall, but would this be better news? Or worse?

Thanks so much for any guidance...

Plastic said...

Dear Anonymous,

Let me first start off by saying that it is sometimes difficult to know with 100% certainty what is occurring on the inside of a tummy tuck when such situations occur. Your history of ongoing seroma accumulation in the post-operative period certainly makes the presence of a pseudobursa reasonable. Although muscle plication itself does not directly add to the chance of a pseudobursa, sometimes the suture material used can increase that likelihood if additional factors are present.

The time for pseudobursa prevention is in the operating room and in the early postoperative period. Once formed, the ability to moderate it in terms of size of thickness of the capsule is relatively minor.

If you are bothered by the appearance of your abdomen secondary to fullness caused by the pseudobursa or by the sensation you have described and it is not improving with conservative treatment then surgical intervention may be warranted. Removing the pseudobursa, especially if large, is sometimes the best course of action. One of the chapters in The Atlas of Abdominoplasty deals with this specifically as we have found that "biting the bullet" when conservative treatment fails is often the only definitive treatment for pseudobursa.

All the best,

Dr. Repta

Anonymous said...

Thanks, Dr Repta. I'm being examined by both a general surgeon and my original PS this wednesday. The appearance is actually not too bad, I mostly like the way it looks now, the main problem is definitely that belt-like tightness across the mid-section that I constantly feel, esp. during/after being in a seated position for more than a few minutes.

It really scares me to think I could have to undergo another operation, and that there's a chance it might not even work. Also - do PS's have a rule of thumb for how they deal with payment issues in situations like these? i.e. do they pitch in here or would i essentially going to have to pay for TWO tummy tucks now?? Scary and depressing in multiple ways.

Anonymous said...

Dr. Repta,
I had a tummy tuck in Feb.2010 outside of the U.S.. A seroma occurred in the area below the navel and above the bikini scar. It was aspirated 4 times before returning home and seemed to be healing. However it never completely went away and now looks like a hard bulge with slight fluid waviness. I have seen a local PS and he recommends reopening the incision and removing the PB. He mentioned a possible complication from this procedure could be skin necrosis occurring afterwords. Is this a common occurrence in dealing with a Pseudobursa? How often does this happen and how is it handled? Would it be O.K. to do nothing with the PS. Do they grow bigger over time?

Dr. Remus Repta said...

Dear Anonymous,

At 6 months there might still be some time for maturation your tummy tuck in terms of healing. Waiting a while longer perhaps 3-6 months may not be a bad idea if you are hesitating having anything done. In terms of treating the pseudobursa I have not seen any blood flow issues to the lower part of the abdomen after pseudobursa removal in my patients. This however is dependent on how the surgery is performed. If you are in the Phoenix/Scottsdale area and would like a second opinion I would be happy to do so at no charge.

All the best,

Dr. Repta
Phoenix/Scottsdale AZ

kari said...

Dear Dr. Repta,
I am 3 weeks postop full tummy tuck. Three days ago at a stop light I was struck by a vehicle moving about 55 mph. The seat belt left a bruise on the right side of my scar and my upper midabdomen feels like it did the first day postop.My abdominal muscles feel very tight.Do you think this could impact my healing in any permanent way. What should I watch for?

Dr. Remus Repta said...

Dear Kari,

Sorry to hear about your accident. I would watch for fluid collection which can be seen as a fluid wave when the abdomen is tapped with your fingers. Sometimes this is difficult to determine but if present it means that you have accumulated some additional fluid under the tissue and it would benefit to have it drained.
In the meantime, both for treatment and prevention it might be a good idea to wear your abdominal binder again for a week or two. This will help compress the tissues together. I hope all goes well.

All the best,

Dr Repta
Phoenix/Scottsdale AZ

Anonymous said...

Dear Dr. Repta,

Thank you for this discussion. I am five weeks post op from hernia repair and tummy tuck. A seroma formed after the second drain was removed (2 weeks post op) in the area you've described as the most common one for a seroma, below the belly button and above the incision. I had it aspirated once, and have been monitored every 10 days since the aspiration. It's still there, slightly smaller than when it was aspirated but not enough to drain again. My concern is that it's not getting any smaller despite compression and limited activity. How long does it take for a pseudobursa to form? Should I request more aggressive treatment, such as another aspiration? And, lastly, there is some puffiness around the seroma; is this new swelling or could it be a PB forming?

Many thanks in advance. All best.

Anonymous said...

I totally think I have this!!!

I had gastric bypass May 09. Had a tummy tuck May 10. I went from 280, to 129.

I've done all of this through military doctors, on an Army post hospital.

Immediately, I began to have a reoccuring seroma in a ribbon above my belly button. It's 4 inches high, 1 cm deep, and from one side of my waist to the other.

I have had 5 jp drains, 5 packing holes that I stuff with gauze for a few weeks, and one seroma exploratory surgery. I wore the binder faithfully for nine months, my doc thought compression would help, but it feels like a rolling pin underneath my skin being pushed into my internal organs.

So I want to get this fixed, and he won't do resurgery. Also my tummy tuck looks awful.

I want to get on with my life, but he thinks the seroma shouldn't be painful, shouldn't make me swell at night to looking 5 months pregnant, he just wants me to keep taking vicodin, and live with it or something. he thinks eating too many carbs could make my belly swell this badly at night.

Should this reoccouring seroma hurt and swell this badly at night? How can I convince him to fix this for me? Would the fixing of the reoccouring seroma make my belly look better as well?

I am sooooo excited to find this post. I feel like I've just selfdiagnosed here, and that there is after 11 months of this, finally an answer for me!!!!!!!!

Dr. Remus Repta said...

Dear Anonymous,

Sorry to hear about your experience. The details of your recovery certainly makes it likely that you have a pseudobursa. Its hard to know for certain all that is occurring in your tummy tuck area without examining you but we can be fairly sure there is an excess of scar tissue secondary to your protracted recovery and healing. Often the best diagnosis and treatment is the same and involves re-elevating the entire abdominal soft tissue, removing all of the pseudobursa and any foreign bodies such as suture, drains, and abdominal binder. Essentially re-doing the whole thing.

Wish you the best of luck. Keep me posted on your progress.

All the best,

Dr Remus Repta,
Plastic Surgery
Phoenix/Scottsdale, AZ

Anonymous said...

Dr Repta,
Thanks for taking the time to answer questions - love ur posts! I had a tt in 6/11. Within 2 weeks, developed a seroma that was drained several times. About 8 wks after, developed another seroma..this one right above my belly button. Went in weekly to have it drained...last 2 times, no drainage..but, still a noticable bulge....and it is hard to the touch. PS says it is a 'seroma cavity' and he can go in through my belly button and do lipo on the area to make it go away. Wants to wait until Jan...approx 6 mths from original surgery. He has never mentioned 'pseudobursa'. Do u think lipo will get rid of all the scar tissue/bulge? Thanks for ur help :)

Dr. Remus Repta said...

Hello,

Liposuction to treat pseudobursa is an alluring idea since it greatly simplifies the solution for the patient. When liposuction is used in this scenario the idea is really to have the two walls of the seroma cavity get inflamed and heal to each other thereby eliminating that potential space. In doing so, the pocket is eliminated but the walls of the pocket, the actual scar tissue part of the pseudobursa is left behind. My reasoning for this answer is as follows. The walls that form a pseudobursa are smooth layers of scar tissue. Liposuction removes fat (hence the name lipo) by having fat globules sucked into the cannula opening. The walls of the pseudobursa will not be sucked into the cannula opening and will definitely not be removed in any appreciable form--other than the occasional small piece here and there. I think some of the occasional benefit of liposuction of a psedobursa is removal of some fat overlying the area above the pseudobursa. In doing so the area is flattened some and the bulge of the pseudobursa is camoflouged. You cannot go longer by waiting longer. Often the best way to take care of something like this is to go back in there at some point and remove all of the excess scar tissue.

All the best,

Dr Repta

Anonymous said...

Thanks for ur prompt and thorough answer. Sounds like lipo is a good solution...but, perhaps not the best since the scar tissue will still be present...even tho all the fat will be gone!
What in ur opinion would be a better solution? Or would you still opt for lipo through belly button?

Dr. Remus Repta said...

I would have to examine you to answer accurately. There is not much to loose by doing the lipo. I am more a proponent of removing the pseudobursa as doing so is actually addressing the problem whereas liposuction is more a method of camofloging.

Dr Repta

Anonymous said...

Dr. Repta
I had a tt on 2 sept 2011 and I've developed a seroma one week after. I've been going ones a week for drainage but the seroma keeps coming back. It's begin 2 months and I look like am 4 months pregnant my tummy is hard and very tender insider can this be PB or is this too early

Amar308 said...

Dr. Reputa

I had abdominalplasty surgery in July 2011, I had two drains but my right drain was pulled in the recovery room. After that the right drain would drain from incision site. I had a mass like above my incision. I still have it its palpable and when I get near the heat it swells. Its uncomfortable, I have told my cosmetic surgeon which is board certified, about my problem. He says he doesn't see anything, he doesn't bother to palpate it, and if a CT Scan doesn't show anything, then that there is nothing there. I told him just bc it didn't show anything didn't mean that there wasn't nothing bc I felt something there. I tried telling him about pseudobersa possibility he denied, denied. I think that his ego doesn't let him see the picture.. What is your opinion?

Dr. Remus Repta said...

Hello Amar308,

Although an examination would required for me to be able to give specific advice on what is likely to be occurring we can discuss a few issues.
The first is the drain. I only used one drain and drape it across the bottom of the abdomen. Some plastic surgeons use 2,3, and sometimes 4 drains. I personally believe one well placed drain is sufficient the vast majority of the time.
The second issue is the fullness you are experiencing. It can be that you may have an early pseudobursa that does not show up on CT. It may also be that you have some excess fat in the area that is still in the process of regenerating its lymphatic channels. This second issue is sometimes hard to differentiate but a combination of examination and evaluation of how you are continuing to heal/have been healing often helps answer the question.
If it is a pseudobursa it will likely get worse or more pronounced (although not always) with time, while if it is a lymphatic issue it should improve with time.
Try and talk some more with your plastic surgeon. Also, no harm in getting a second and a third opinion if you think that is necessary.

All the best,

Dr Remus Repta
Scottsdale, AZ

Anonymous said...

Dear Dr Repta

I had smart lipo 4 months ago. My surgeon used a single drain but from day one there were fluid problems. The drained clogged multiple times and the doctor has to aspirate the fluid (seroma) a couple of times, with lots of fluid coming out each time.

Then I waited, the fluid came back, but I was told it should go away by itself. It didn't. Instead, it hardened, and now I feel a hard tissue just below the surface. It has formed a really large bulge where the fluid was before, and reading your post I'm afraid it can be a pseudobursa. Not sure hoe much fluid is inside but if I press on one side it seems to grow on the other.

The original surgeon has recommended to wait 6 months from the original surgery to do a fix-up. Other plastic surgeons have recommended ultrasound, lymphatic massage, RF, steroid injections, etc. I'm lost really, and I want to get rid of this problem.

Do you have any recommendations?

Thank you

Dr. Remus Repta said...

Hello Anonymous,

Thank you for your question regarding possible pseudobursa following smart lipo. It sounds like your smart lipo session was an aggressive one since a drain is only utilized in aggressive lipo sessions. The aspiration of seroma on multiple occasions certainly makes it possible that your body has developed a pseudobursa. With laser lipo, this possibility is hightened as the laser lipo process delivers heat to the surrounding area and essentially causes a burn within the fat, stimulating the body to form additional healing fluid (seroma). If you still have fluid in at this time it may be reasonable to place a drain and diligently wear a compression garment. At some point in the future, perhaps at the 8-12 month mark you may need to evaluate whether the fullness and hardness is improving or just staying the same and if so what to do about it. At that time, full removal of the pseudobursa can be performed if so chosen.

I hope this helps.

All the best,

Dr Remus Repta
Phoenix/Scottsdale, AZ

Amar308 said...

Well finally it wasnt psuedoobursa it was a umbilcal hernia. My general doctor performed the repair the bump in my lower abdomen was actually the hernia sac. He performed a ultrasound and physical palpation. So my plastic surgeon was surprised bc he had sent me to get a ct scan and ultrasound wasnt seen then 3 months post op. He told me that he didn't perform hernia repairs. But he could refer me to one. But my question would be dont you check for hernias prior surgery or you wouldn't be able to tell when performing a tummy tuck if someone had umbilical hernia during surgery? Well now im stuck with another surgery,cost, and down time.

Dr. Remus Repta said...

Hello Amar308,

I am glad to hear that you received more information regarding your diagnosis. An umbilical hernia and/or ventral hernia can be repaired at the same time as a tummy tuck if they are present. If they occur afterwards the tummy tuck can be redone and the hernias fixed in that fashion to minimize the scars or traditional hernia incisions can be performed. Most plastic surgeons do not get special tests to evaluate for hernias since this will not change the plan, instead we rely on physical examination to facilitate discussion on what may need to be done during surgery.

All the best,

Dr Remus Repta

Anonymous said...

I FEEL LIKE I HAVE FINALLY SOLVED A MYSTERY, I HAD A TT ALMOST A YEAR AND A HALF AGO AND HAVING PROBLEMS SIMILAR TO DESCRIBED, MY TT WAS NOT WITHOUT INCIDENT THOUGH I HAD DRAINS IN FOR ABOUT FIVE WEEK ONCE FINALLY PULLED SWELLING CONTINUED HAD DRAINED A COUPLE TIMES AND SURGEON RE-INSERTED A DRAIN FOR ANOTHER TWO WEEKS, SOME SWELLING AGAIN WENT TO SURGEON HE TRIED TO DRAIN AND COULD NOT 4 DAYS LATER MY INCISION SPLIT OPEN AND DRAIN INFECTION IT WAS HORRIBLE. I REALLY BEGAN TO FEEL LIKE A CASE TO MY SURGEON, I CONTINUE TO HAVE BURNING PAIN FROM RIB CAGE TO PUBIC AREA WITH MAJOR SWELLING IN THE PUBIC ARE, I TEASE AND SAY I LOOK LIKE A VERY WELL IN-DOWED "KEN DOLL" I HAVE GONE TO FP AND GYN TO RULE OUT ISSUES (USUALLY JUST TOLD LARGE AMOUNT OF SCAR TISSUE, BUT I DONT THINK SCAR TISSUE CHANGES IN SHAPE SIZE AND FIRMNESS???) FINALLY WENT TO AN URGENT CARE AND SHE THINKS I MAY HAVE A HERNIA AND TALKED ME INTO GOING BACK TO PS AND NOW I AM GETTING U/S IN THE MORNING I FINALLY FEEL LIKE I'M GETTING SOMEWHERE AND DON'T THINK I SHOULD KEEP WAITING TO SEE IF IT GETS BETTER AT THIS POINT I THINK 16 MONTHS IS PLENTY OF HEALING TIME RIGHT? IF THIS IS PSEUDOBURSA WILL IT SHOW IN U/S? HOW DOES PS CHECK FOR PSEUDOBURSA? I REALLY JUST KNOW SOMETHING IS NOT RIGHT, IF THIS IS NOT A HERNIA I WILL BE ON THE NEXT PLANE TO SEE YOU, IS IT A LONG WAIT TO GET IN FOR AN APPOINTMENT??

Dr. Remus Repta said...

Hello Anonymous,

Thank you for your question. I am sorry to hear about your struggles with your recovery. From what you have told me it sounds like you have had a very prolonged healing phase. In general, prolonged need for drains and continued symptoms as you have experienced may indicate your body was in a continued or prolonged inflammatory phase of healing. This can occur for several reasons including light ongoing infection, bleeding, or seroma. Regardless of source, it is likely that this prolonged inflammatory phase has resulted in extra scar deposition, aka pseudobursa. The real question is what to do next. Regardless of the results of the ultrasound it sounds like you have and are continuing to experience discomfort that is not improving. From my perspective the time that has passed was sufficient to allow conservative management to work. If this has not provided the results that are needed than you may need to entertain the idea of going back in and exploring and repairing what needs to be done. I hope this helps.

All the best,

Dr Remus Repta

Anonymous said...

I am 6 mos post op and have this ps thing. My dr. keeps saying I should wait until August and see how everything looks then. I beleive he should operate and remove it and it should not cost me a dime, I already shelled out 13K for my tummy tuck and breast lift. Are these fixes usually paid for by the surgeon? I live in St. Louis, MO.

Dr. Remus Repta said...

Hello,

Its sometimes difficult to determine what the best timing is for exploration. Waiting a few more months early on in your recovery can sometimes be helpful as the healing phase has more time to mature. If your plastic surgeon feels that a few more months might be helpful to you and him/her in terms of making a clinical decision it might be best to follow that advice. In terms of paying for revision surgery, this is something that needs to be decided from surgeon to surgeon and from situation to situation. Your surgeon may offer to do his/her part without charge but there will undoubtedly be a fee for anesthesia and the operating room.

All the best,

Dr Remus Repta
Phoenix/Scottsdale AZ

Anonymous said...

Hello, Dr. Repta-

I had a tt on 4.16.12 and had one jp drain for 8 days. I developed a large seroma and the first time my ps aspirated it, he pulled 360cc. The second time, 3 days later, he pulled 420 ccs. The third time, which was 5.4.12, he was only able to pull 40cc but it appeared that approx. 100-150cc of fluid remained.

Is the reason he was unable to pull more fluid due to a capsule being formed? The "waterbed" look has diminished significantly from the first aspiration, but it is still present. Will the remaining fluid resolve itself, or will a PB prevent that if, in fact, a PB is present?

Is there a way to excise a PB without having to reinsert drains?

I have another appointment on 5.7.12. Should I allow the PS to attempt to manually evacuate the seroma again? As of now, my lower abdomen protrudes quite a bit, preventing my belly from looking flat...however, I AM only 3 weeks post-op. My doctor is unwilling to utilize any sclerosing (sp?) agents...and as you indicated, they are mostly unhelpful.

Thank you SO much for all your responses!!!!

-jjt

Dr. Remus Repta said...

Hello jjt,

If you still have visible or palpable seroma fluid it should be removed. Your plastic surgeon can attempt to aspirate again. This can be done in the standing position which may help collect all of the fluid in the center near the horizontal incision. If there is still no success or the amount of fluid is significant a seroma catheter or a drain can be inserted. By numbing up a small portion of your incision a drain can be reinserted through your incision. This can be done in the office under local anesthesia. I would wear your abdominal binder diligently during this entire process until the seroma is no longer an issue.

All the best,

Dr Remus Repta

Anonymous said...

Thank you, Doctor.

Well here it is, two days since the futile attempt to aspirate the seroma and there is virtually NO wave like appearance on the surface of my abdomen. What is there now is a quite large uncomfortable bulge that is firm and tender to the touch. Pseudobursa, right?

So if my ps tells me he's taking me back into surgery, can he remove the pb and stitch me up in such a way that I won't have to have a drain? I hate the drain and it didn't do snt good the first time and it hurt SO BADLY when the doctor pulled it.

Thank you thank you thank you. You have more bedside manner online than my ps does and I paid him lots of money!

jjt
houston, tx

Dr. Remus Repta said...

Hello jjt,

Going back to surgery to explore and repair as needed is probably the best way to proceed. If you have a pseudobursa at that time your plastic surgeon should remove it. To prevent the pseudobursa from recurring your surgeon can place quilting sutures which are an attempt to obliterate the potential space between the abdominal soft-tissue and the abdominal wall. I would also strongly recommend placement of a drain. As much as the drain is hated by everyone it would be better to have the drain and prevent a recurrence of the pseudobursa. The drain should be placed horizontally along the bottom of your tummy tuck. You should wear your abdominal binder non-stop for about 48 hours and religiously thereafter for about 4-6 weeks thereafter. When the drain is pulled out your plastic surgeon should check you every other day for the first week to make sure that your are not accumulating seroma fluid.

All the best,

Dr. Remus Repta

Anonymous said...

You're amazing. Oh how I wish I were where you are! I would much rather have a surgeon who delineates each step of the process to me. I will be sure and inquire about the things you've listed here. Thank you so much. I feel much less blind going into this second procedure.

-jjt
houston, tx

Anonymous said...

Dr. Repta,

I went back into surgery 5.9.12 (after my original tt on 4.16.12). My PS excised a hematoma and drained a large seroma which he said was beginning to form a capsule. It is 5.13.12 and I still have a drain. The first time I had the bulb drain for 8 days. This time I have a Davol drain and I'm not draining very much fluid, just as I didn't the first time. Additionally, today I'm experiencing a little discomfort where I think is the site of the drain. (I can't see because I'm still bandaged)

I have been wearing my compression garment 24/7. If my PS removes my drain at my next appt on 5.15.12, I will have the nurse put me in an even tighter garment.

What else can I do to be sure that another seroma doesn't occur or hematoma. The hematoma I had was VERY tender to the touch and just...ugly.

Also, do you think 6 days is long enough to have the drain in?

Thank you.

jjt
houston, tx

Dr. Remus Repta said...

Hello Jjt,

I'm glad you're doing well after your surgery. I'm surprised your drain is not putting out that much. It's not necessarily abnormal but I would have imagined that your body would be putting out some fluid after your surgery. Before pulling the drain out I would make sure you are not accumulating fluid and that the drain is functioning properly. It would be better to keep the drain in longer rather than shorter. From your perspective keep wearing the binder tight and low and try to minimize activity.

All the best,

Dr Remus Repta

Anonymous said...

What if my PS discovers that seroma fluid IS in fact accumulating despite the drain?

What would you do if you found this out?

I wish I could give you more specific detail about the amount of fluid that is collecting in the drain, but as you know, it's difficult to gauge by looking with a Davol drain. I don't want to empty it and measure it because it's nowhere near the 400 ml capacity and I want my PS to see how much fluid collected since he emptied the drain on 5.11.12 at my follow-up.

Thank you!

jjt
houston, tx

Anonymous said...

Dear Dr. Repta,
I had a tummy tuck in 2005 and a revision in 2007. I was having a small amount of discharge from my belly button. I had an open laparatomy in 2008, where my ob/gyn said I had a seroma. He was in there for another reason, so he would not fix or remove it. I went to the plastic surgeon who tried aspirating from it, sent me for ultrasound guided procedure, followed up with a general surgeon who did ct scans and said let's wait and see if it gets smaller. After time it got a little smaller. Now, I am having more noticeable purulent discharge and bouts of nausea. I'm wondering if the nausea could have anything to do with it? So, pretty much my issue ie unresolved. The original plastic surgeon won't touch, the ob/gun won't either because he said he didn't do it to begin with and the surgeon doesn't think it is a big deal. Today, my abdomen is very sore, tender and somewhat distended. I can't live like this and i don't know what else to do. It's also embarrassing if I sit and my pants press on my tummy and some fluid comes out because I know I can smell it. Please help!

Dr. Remus Repta said...

Hello,

Sorry to hear about your experience and symptoms. It sounds like you can benefit from having the area explored and cleaned out. This can be done in a small way just at the area around the belly button or in a formal fashion essentially redoing the entire tummy tuck. From what you describe I am in favor of the more formal full correction as a small incision and clean out just at the belly button will likely result in the problem concurring again. Its a difficult situation that will require some down time for recovery and unfortunately some expenditure of money but its better to correct the problem once and for all. Obviously I am not there to examine you but from what you have told me it sounds like an infected pseudobursa. The pseudobursa and the related sutures should be removed. Drains should be placed. And an abdominal binder should be worn.

All the best,

Dr Remus Repta
Phoenix/Scottsdale, AZ

Anonymous said...

Hi Dr Repta,
So is this something you recommend I go to the original surgeon for or someone who specializes in revisions? I am in the east valley and have had this problem for quite some time with quite the run around.

Dr. Remus Repta said...

Hello,

If your former plastic surgeon feels comfortable addressing this then he/she might give you a discount off of their surgeons fee. If either your surgeon or you feel uncomfortable then seeing another plastic surgeon, particularly one that deals with revision tummy tuck surgery might be ideal. If you live in the Phoenix/Scottsdale area or nearby I could give you a second opinion/better idea of the diagnosis and plan. Office phone # is 480 752-7874.

All the best,

Dr Remus Repta

Anonymous said...

Dear Dr. Repta,
I am 16 mo post op TT with multiple hard lumps with major tightness and tenderness down my mid- line and off to the left of it from my diaphragm down to my pubis. I have had several attempts to "drain" these and no fluid has come out. They can feel more sore at times and occasionally warm to the touch. I had no issues initially with the TT but within 4 months I started noticing the hard knots. Then I developed blisters (one at a time) around my belly button that were addressed by my surgeon via a cut and suture closure. Then after the 4th time he decided to make an open wound around the entire belly button looking for the "suture material" and we (my hubby and a nurse) packed it 3 x a day for almost one month. Within 1 week of the closure of the wound, another blister showed up. I am so frustrated, sad and confused. I have spent more time dealing with the wound that won't heal and pain and I just want this to be different. I waited to see if the wound may heal on it's own but to no avail. The PS opened it again, searching for the "suture" or "foriegn body" and nothing was found. I asked if we could UN DO this entire procedure and he said he is extremely concerned about doing another procedure on me as I have not faired well this time with these complications though he is contemplating removing all permanent sutures and not replacing with anything. After reading your posts, it seems to me there may be a solution that is better than this. Do you believe I have pseudobursas from Ethibond sutures? Can it be redone without permanent sutures and still end up with Psuedobursas? Have you been able to help someone like me?

Dr. Remus Repta said...

Hello,

I am sorry to hear about your experience. It sounds very much like you have permanent sutures (likely ethibond)that are causing the continued source of your problems. Along these sutures you have also likely developed scar tissue that the body has deposited in the attempt to isolate the inflammatory and infection process. Although the body can isolate this process it has shown you that it is struggling to do so and desires very much to push the infection/inflammation out. I have taken care of similar type situations in a handful of patients and the best answer is almost always to go in, re-do the entire tummy tuck, remove all of the sutures, remove all of the scar, wash everything up, put new drains, and allow your body to heal properly.

All the best,

Dr Remus Repta

Anonymous said...

Dear Dr. Repta,
Thank you for your response to me regarding the infection/inflammatory response my body is doing with the blistering. If a re-do is in order what sutures would be used in place of the ethibond? Would they be permanent as well? In your previous patients presenting with the same symptoms, how long before they felt better and weren't looking over their shoulder waiting for the same thing to happen? How much harder is it to re-do? What about other complications because of the re-do? I feel hopeful that I can have a different outcome but I am so apprehensive and scared that it will be worse, but I really don't have any options except to re-do or live with the repeated open-wound/blistering and hard lumps/pain...
I really appreciate your answers and time you are taking with me, although you haven't had an opportunity to meet me.

Dr. Remus Repta said...

Hello,

Getting all of the suture material and scar tissues our is the key to putting this issue to rest. If you need muscle tightening I would use looped nylon or looped. The looped PDS eventually dissolves. There is a chance you may not need any additional muscle tightening as it has been long enough that the sutures are no longer needed. The key I think is not doing the next step half way. All of the scar tissue should come out, all of the sutures should come out. Drains should be used and use of the abdominal binder should be consistent.

All the best,
Dr Remus Repta

Anonymous said...

Thank you Dr. Repta. I look forward to meeting you and I pray you are able to help me.

Anonymous said...

Dr. Repta~
In the repair you suggested when all suture material needs to come out, all scar tissue needs to come out, do you recommend not placing ANYTHING back up the mideline wall? My PS wants to "cut straight up the middle" (I understand to be the complete plication pubis to sternum) to make sure he isn't missing anything, take all the material out (scarring, sutures, et al) and then NOT put anything back in it's place. He says the enemy of "perfect is good" and right now to put to rest the effects I am experiencing this is the best option and the only one he wants to move forward with.

I am concerned that after being closed for a year + and now opened and left opened I will have other issues like muscle seperation, diastisis (which I had surgically repaired originally during a hysterectomy), weaking of the muscle wall etc.
Have you ever known of this type of remedy to be used? To cut and not replace?
My doc is board certified and continues to meet me and has been understanding and working me in to get this remedied, but I am not at peace, and unsure if I will be as this doesn't sound like repairs that have been made to other patients who have responded like me to the Ethibond.
I am trying to stay with him as he knows my anatomy, says he wants to see me better and isn't looking at the cosmetic side now as much as the medical side. He said the surgery is 20% muscle plication, 80% skin removal and I should be no different than I am now as the muscles have relaxed, except free of the pain.

In your experience, does this sound like a problem, or a solution that will bring the best outcome?

Anonymous said...

DR. Repta,
I Had emergency surgery after some muscle separtion in my stomach. Still not clear if it was a hernia or what? (Prior to surg)) When i did set ups my whole stomach raised almost to a point when that muscle was used. I have had 5 kids and 5 c-sections. Before the surg i ask the doctor , cant you do a tummy tuck too and lipo suction my hips? He said yes. He is a Gen surgeon. I am a ER nurse at this hospital! I guess he did it out of coutesy to me. The hole in my stomach he said was 7" across and 9" long...a large incision all the way down my belly. I also have the incision from a mini tummy tuck. I coded 2 hours post procedure. They had to give me 9 units of blood and a unit of platelets. He never opened me back up ...just sent me to ICU. I had no drainage tubes from "mini" tummy tuck (but hip to hip incision),I had 3 Jp drains higher up from/for vertical muscle correction incision. 1 on top and then 1 on each side of that incisions. #1 JP came out the day i left hospital, #2 came out a month later, #3 came out 2.5 months later.
The vertical incision seems ok ....where the jp drains were especially the last one hurts really badly. The lower left side of tummy tuck feels like nothing but very hard painful hard rocks, I have sinse had 2 holes (tunneling) appear in that incision. I have packed my own holes with iodiform and a sterile stick with no healing process being seen. I am post +4 months. I have recently took a shower while off working and massive blood started shooting out of one of the holes(alot). I do plan on going back to see my second opinion dr on my return home but until then ....Do you have any advice? I feel so batched! I do not see where I had anything (fat)off my tummy....what is going on with this incision?
Thanks for your ear aka eye!

Dr. Remus Repta said...

Hello ER nurse,

If you had a blood transfusion we must assume that you lost a sizable amount of blood during or after your surgery. Since your drains were left in for so long I suspect your bleeding occurred between your abdominal muscles and the abdominal soft tissue (skin and fat). This is the plane where the dissection occurs for a tummy tuck. The blood that you have seen shooting out of your tummy tuck scar may in fact be seroma fluid that contains dissolved hematoma. If this is the case it is not new bleeding just old blood that your body is trying to get rid of. If the above scenario is what is occurring you most likely also have quite a bit of scar tissue that has developed as your body has struggled to contain and manage the hematoma and seroma. The next step depends on your symptoms, your appearance, and what you would like to achieve. I am a bigger proponent of going in and redoing everything as opposed to just doing a very small procedure to attempt to manage the problem as this often results in continuation of the problem and repeat "small procedures".

All the best,

Dr Remus Repta
Phoenix/Scottsdale, AZ

Dr. Remus Repta said...

Hello Anonymous (ethibond re-do surgery).

Since it has been months since your original surgery your abdominal wall plication (tightening) may have healed. If this is the case no additional suture for muscle tightening is needed at the time of your tummy tuck re-do. If you are in need of muscle tightening at the time of your second surgery I would use a looped PDS or looped nylon as this will accomplish the job and provide the body with a smooth suture (ethibond is braided) and much less overall material. Again, all of the scar tissue from the pseudobursa should be removed, all of the old sutures should be removed, drains should be placed, and an abdominal binder should be used diligently.

All the best,

Dr Remus Repta
Phoenix/Scottsdale, AZ

Anonymous said...

Dr. Repta,
I had TT out of country. My drain was removed on 9th day when it still had an out put of 50cc/24hrs.
I flew back on 10th day and now after a week below the belly button and between the incision line there is unusual swelling. I can feel the waves of fluid. When i press on one side the fluid creates waves on the skin.
I email my doctor and he said there are two ways to treat seroma one way is to leave it alone all seromas are eventually absorbed by the skin or do aspiration.
My question is should i do aspiration with a general doctor or is it important to have it done with a ps
Thanks
Elly

Dr. Remus Repta said...

Hello Elly,
Your body may be able to absorb the seroma on its own but doing so will increase the chance of a pseudobursa formation. I recommend seeing a plastic surgeon and having them drain your seroma in the office using a needle through your horizontal incision. This should be done and checked twice or three times a week. After the first week or so it will likely be gone. During this process it will be important that you wear your abdominal binder very tight and consistently.
All the best,
Dr Remus Repta

Anonymous said...

I had a diastasis repair and hernia repair and mini
Tummy tuck a little over a year ago. My doctor also did some body contouring with lipo. I was left with uneven, swollen and sagging skin. He went back in in January to perform a full tummy tuck. I am now and was then fit and weighing 112. My stomach issues were due to having 3 children and muscle separation. After the second surgery I had one drain in for almost two weeks. The swelling lasted a while...well in May he went back in through a small incision in his office and used an instrument to break up scar tissue in one area on my belly next to my belly button. Since then I have been in every few weeks to drain fluid...finally no fluid was aspirated but I am left with an area the size of a golf ball. It is un even and ripply...his only suggestion is to massage the area to break it up. I was so happy to see our blog - my doc said he had never seen anything like this and blamed it on my body healing. At this point I don't trust him and would like to go see another doctor. He informed me that he has monthly dinners with al board certified PS in my area...his way of saying "don't go shopping around". Those were his words. Can I send you a picture of the area...seeing doc on Wednesday and would like to have some idea of whether or not I have a psuedoobursa. Thanks for being so helpful and honest. Wished I lived in your area.
I am in Nashville, TN

Dr. Remus Repta said...

Hello from Nashville,

I'd be happy to look at your photo and give you my professional opinion. Just email your photo to my office manager at LelsieRN@aaaplasticsurgery.com

All the best,
Dr Remus Repta

Albany Point said...

Dr. Repta,
Thank you so much. Isent a few pictures as well as my contact information.
I appreciate your opinion...
Nashville

Anonymous said...

Hello Dr. Repta,

I will be having a tummy tuck with muscle repair (no lipo) soon and I'm afraid of these complications. Can you please give me the best advice you can to attempt to prevent seromas and the resulting psuedobursa?

Dr. Remus Repta said...

Hello Anonymous,
Most of the things that will be important for you to avoid complications will be in the hands of yor plastic surgeon. If you choose a well qualified board certified plastic surgeon that has experience in tummy tuck surgery you will have done almost all that you can do. Following his/her instructions after surgery will also be important. Good luck and think positively as I am sure all will be well.

All te best,
Dr Remus Repta
Phoenix/Scottsdale AZ

Lisam said...

Hello Dr Repta
I had a full tummy tuck with lipo end of May 2012. Within the first week I experieced a searing pain in my right side just below my incision whenever I would change positions while in bed or laying down. My PS has found nothing wrong, I can push on this area with no pain, yet I still have pain lasting a few minutes on ocassion. I am wondering could I have the start of a hernia developing caused in part from the muscles being pulled and stitched tightly? I think I feel a small hard lump, but not 100% sure

Dr. Remus Repta said...

Hello Lisam,

If you can pinpoint the pain with one finger, since the pain is below your incision as you have stated, and if your pain increases with stretching your waist or leg (putting tension) on the incision area, the pain is most likely related to a nerve. It was most likely caught in a suture during closure of the abdominoplasty. This can be released surgically or you can simply just massage it and give it more time. Sometimes this condition also causes a little numbness on the front side of the thigh.

All the best,
Dr Remus Repta
Phoenix/Scottsdale, AZ

Lisam said...

Thank you Dr Repta

Yes its as you describe, and happens when stretching the waist/leg, but I do not have any numbness in the top of my thigh. My PS used permanent sutures, closing the underside of my incision with what he called a running suture hip to hip. The outside of my incision glue was used. The fact that I have interior permanent sutures, will massaging still help the nerve?


Cheers

Dr. Remus Repta said...

Lisam,

Massage and more time can still help. If your symptoms continue to improve I would continue doing so. If your symptoms stop improving then that may be a time to entertain the idea of dealing with that suture.

All the best,

Dr Remus Repta
Phoenix/Scottsdale, AZ

Anonymous said...

Dr. Repta,
I had smart lipo in 2008 on my hips and knees. Seromas developed on both my knees and they where drained and then my doctor said that was all he could do. I have what I think is a large pseudobursa that had developed over both my knees. on my left knee it is bigger feels heavy and the skin is so streched it is over the knee trying to hold this thing. It feels somewhat numb and think, but still soft to the touch but hard if pressing hard to the touch. Do you do surgery to possibley remove this. I can send you pictures I just don't know who to trust. I am in San Diego , but willing to travel.

Dr. Remus Repta said...

Hello Anonymous,
Sorry to hear about your ordeal. Seroma and healing issues as you have described can be seen after excessive laser lipo where a significant amount of heat is delivered. It certainly sounds like you have developed scar tissue and perhaps a pseudo bursa. Removal of this scar tissue would require and incision which would be near the area of question. The good news is that if an incision is made in this area some tightening can also be performed. Please contact Jadie at my office to facilitate sending photos. 480 752 7874

All the best,
Dr Remus Repta

Anonymous said...

Hi, I had a full tummy tuck 9 months ago and my scar is thick, dark, and hard and on my left side sometimes it's painful. I went to my PS several times but the first time I noticed the buldge in my stomach he tried to drain any remaining fluid. He said that it was dried up like a spongre and nothing was coming out at 2 months post op. Now out of nowhere I just developed an abscess on the left side of my stomach right above my sca and the doctor at the ER believes it may be in connection with the tummy tuck because around the abscess it is extermely hard and she doesn't know why. Can you help me out if you have time and give me some advise? Thanks.

Dr. Remus Repta said...

Hello Anonymous,

If the bulge gradually appeared after your tummy tuck then it certainly can be a pseudobursa. A pseudobursa would most likely be located near your horizontal tummy tuck incision and it would potentially cause some tension and discomfort especially when trying to stretch your abdomen. An abscess or draining infection from your tummy tuck incision should be considered as associated with your tummy tuck until proven otherwise. If this is the case, it is very possible that you may have an infected pseudobursa. A common reason for this is the presence of braided permanent sutures used to tighten the abdominal wall. Your plastic surgeon or a plastic surgeon would be the best at validating all of these possibilities. An infected pseudobursa would require removal of all of the pseudobursa and any permanent suture. I have found that redoing the tummy tuck is often the best solution for the issue at hand as well as for the final result.
All the best,
Dr Remus Repta

Anonymous said...

Dear Dr. Repta,

Like everyone has said I am so grateful to have found this post! I can't tell you how much I appreciate you taking the time to reply and with such thorough and concise answers. I had a TT 4 months ago and shortly after my surgery I began to notice swelling in my abdomen. My PS Surgeon does not seem concerned about it in the least and has not suggested any possibilites as to the cause or any possible solutions either. I have no medical background and in no way wish to self-diagnose however, I am curious as to whether this may be the reason for the distention and swelling I am experiencing? I am so disappointed by what is happening and find it very distressing! I will look forward to any feedback you can offer

Most sincerely,

S

Dr. Remus Repta said...

Hello S,

There are several possibilities for swelling after a tummy tuck, among these a pseudobursa may be one. If you have not gained weight, the swelling is either just above the belly button or just above the pubic bone, and your swelling has slowly been developing after an early period of a flat abdomen then a pseudobursa may be the case. An exam would be needed or at the very least photos and a phone consult. You may send your request for a phone consultation via our website: aaaplasticsurgery.com

All the best,
Dr Remus Repta

Anonymous said...

Thank you for your reply Dr. Repta. I see you are located in the Phoenix area as am I, therefore I would much prefer to meet with you for a consultation to get your professional opinion rather than do one via the phone, if you are willing and able. I am so hopeful that the cause can be determined and I would imagine the sooner the better! Thank you once again.

Most sincerely,

S

Dr. Remus Repta said...

Hello S.

That works even better. You can get a hold of my office in the same way through my website aaaplasticsurgery.com or by calling us at 480 752 7874. You can schedule a consultation with the front desk or ask for either Jadie or Leslie who function as the patient concierge.

All the best,

Dr Remus Repta
Phoenix/Scottsdale AZ

GB said...

I had my TT in Feb '12 and was loving it till about a month ago. I started having the feeling that a belt was around my waist and the buckle was pushing into my belly button. I went to my plastic surgeon, he did some mashing around and said I probably overdid it exercising and to just take it easy for 2 or 3 weeks. I've been taking it easy but the feeling is still there and I can see a bulge under my right rib cage. What do you think? If there is something that can be done, I imagine it should be done soon so things don't get any worse. This is very disheartening as I was so happy with my results and recovery up until now. gb

Dr. Remus Repta said...

Hello GB,

Sorry to hear about your recovery. Don't get disheartened. Are you local or regional to Arizona? If so I would be happy to see you in consultation and give you more accurate advice. The location that you describe is a little unique and not the most common area to expect a pseudobursa although it is still possible. The only way to really know is either through exam, CT scan, or surgery. If there is fluid within the pseudobursa you may benefit from aspiration and compression. At this far out if it is a pseudobursa you may need to have it removed to completely take care of it. To do so would involve redoing the tummy tuck and this would involve much of the cost and recovery that was associated the first time. You can also send some photos and arrange a phone consult with me if you are not in town. Just go to my website and request to email Jadie or Leslie who can help you set up the consult.

All the best,

Dr. Remus Repta

GB said...

Thanks for the swift reply. I'm in Alaska so an office consult is unlikely although it's possible I may be in AZ in Feb. I've been doing some massage and wearing my compression garments. I guess I will give it another week and then see my PS again. If things don't improve and my AZ plans get finalized perhaps I can make an appoint with you for a second opinion. GB

khodson24 said...

I finally feel like I have found an answer! I had a tummy tuck and ventral hernia repair March 23,2012. It has been HORRIBLE every since. The pain was almost unbearable for a long time. It felt like I was ripping in half. A had to go to the ER because I kept coughing up blood clots and the radiologist wound up dropping me on my back and it felt like my whole stomach tore apart. After the ER visit I began noticing a painful bulge to the upper left of my navel. It is quite large and it's very uncomfortable. When I sit my stomach cannot bend on that side, it's awful. You can see the bulge through my clothes, I'm so embarrassed of it. My surgeon keeps saying he doesn't know what it is. He wants to send me to a general surgeon because he said there is nothing else he can do. I am SO scared! I don't know what to do. I'm still in a lot of pain, I still have to grab my knees to raise up out of bed, I have hardly any use of my muscles or it's so painful. I hurt everyday, all day and I'm only 31. Do you think it may be a PS? You seem like a wonderful surgeon and I'm so glad I found you!

khodson24 said...

I forgot one thing, I had a CT scan and ultrasound back inAug and it showed nothing but severe muscle swelling in that area.

Dr. Remus Repta said...

Hello Khodson24,

Sorry for your ordeal. Your history, physical exam, and CT scan should shed some light on the source of your pain. The length of your discomfort likely warrants surgical exploration. A pseudobursa may be present. There is also some concern that a neuroma or a rectus sheath hematoma or its remnants may also be present. If your symptoms are improving you may elect to continue with observation, otherwise persistent discomfort at 9 months and beyond should probably be surgically explored.
All the best,
Dr Remus Repta
Phoenix/Scottsdale, AZ

Fitness lover said...

Hi Dr Repta, I think its amazing how u are helping people on your blog! I hope you can help me too. I am a mother of 2 kids who are now 8 and 7 years old and have always had a slim figure. Was just not happy with the loose skin after giving birth.

I had a TT surgery, almost 7 weeks ago and just saw my surgeon after 6 weeks for the first time (prior to that was seen by the nurse 2 & 4 weeks in and was told everything was going well even though I had a bloated/hard belly).

My surgeon looked concerned but did not express himself about my condition or diagnose the issue/problem. He just said that I may need some revision surgery using lipo but will need to wait a further 6 weeks as it could be only swelling. I was stunned when I left the office as I have never had any fat on my belly so why the need for lipo?

Over the weekend I have done some research and I think I may have a pseudobursa (I had a flat stomach and a 6 pack pre OP.) I am confused as to what should be done as most surgeons are aspirating the seroma 2-3 weeks in. I know I'm almost 7 weeks in but is there anything he should be doing? If I need need to be operated, what should the timescales be? Will my stomach every look the same? or will revision surgery have some limitations? I only had one overnight stay after the surgery and the drains were taken out less than 24 hours after surgery!!! Which I am guessing could be the cause of the problem.

I don't want to wait 6 weeks (over 12 in total) if a course of action can be taken now to avoid more problems. I would like to email you my B4 and after pictures if at all possible. Thank you in advance from a very scared and distraught 35 year old.

Dr. Remus Repta said...

Hello Fitness Lover,

Yes, please do send some before and after photos as they would be helpful. You can email them to Jadie: concierge @ aaaplasticsurgery .com and she will get them over to me and schedule a phone consult if you would like. From what you've told me it certainly sound like you have a pseudobursa. You have rationalized it the same way that I would have meaning, if you were thin beforehand you would not have any fat to liposuction now, and if you were relatively flat after surgery and your abdomen has become more rounded in appearance that would all support the possibility of a pseudobursa. If this is the case removal of the pseudobursa would be the ideal treatment as liposuction would not address the main issue. Recovery from a full tummy tuck revision is not as hard as the original surgery and the overall result can be excellent. I believe I have a few before and after photos on my website from pseudobursa revision.

All the best,
Dr Remus Repta
Phoenix/Scottsdale, AZ

Fitness lover said...

Dear Dr, thank you so much for your quick response! I greatly appreciate it and feel like there is hope again. I have emailed you my before and after pics of my TT. I would love to arrange a phone consult whenever you are available.

Thanking you again with all my heart.

Fitness lover said...

Dear Dr, thank you so much for your quick response! I greatly appreciate it and feel like there is hope again. I have emailed you my before and after pics of my TT. I would love to arrange a phone consult whenever you are available.

Thanking you again with all my heart.

Marcela Monjardin said...

Hi Dr Repta.

I have a full TT with liposuction and lipotransfer in my butt in dec 12, 2012 and was ok. In my first revision my surgeon say I have a seroma and try to drain it with a syringe but he can´t. in the next appointment he don't have succeed either, so, he send me to make a ultrasound and there we see in all the line on the scar 4 seromas. My PS suggest to wait to my body reabsorb the liquid, but 1 month exactly of my procedure 1 stitch open and drain a lot of yellow-clear liquid. 10 days later, another stitch open and drain too. Now, 1 1/2 months later still draining both of them and have a little white "balls" (like a pimple) and blood a little in the open stitches. 5 days ago I feel have in my lower abdomen a weight and more swelling and the drain liquid is now like a yellow mucus, I don't have pain and the liquid has not bad odor. My surgeon sugest me a second procedure to "remove" the seroma. It is correct? Thanks for your help

primemover said...

Dr Repta,
What a blessing you are to the community of women experiencing apparent seroma/ Pseudobursa problems. I am the husband of a woman that has a MommyMake Over, including tummy Tuck. She developed a seroma, with the classic swelling and "waterbed" fluid bag. She said is felt like an internal blister. A pseudobursa did develop and ultimately was removed by plastic surgeon.

I am respectfully listing things that we tried and medical specialties consulted before the last surgery solved her problems. I am not a medical professional and I always recommend that people follow the advice of your trusted Plastic Surgeon.

We travelled to Cancun, Mexico for the original mommy makeover and received wonderful care from an experienced surgeon. We stayed for 13 days and had check ups with the surgeon every 3 days. Both before and after returning to the US, my wife wore her compression garment 24/7 except for showers. Abdominal seroma's are not obvious when a woman is laying down. But standing up, we could see the obvious swelling that was soon diagnosed as a seroma.
Our local plastic surgeon attempted to drain the seroma with needle and removed 40 cc. But it was obvious there was more fluid and she did not want to risk poking around with the needle blind. So she referred us for an ultrasound-guided, fine needle aspiration from the radiologist team. They worked out of the Breast Diagnostics department. Another 200 cc was aspirated the next day. My wife went back for seroma draining every 10 days for 6 more visits. As I made the appointment for the 6th aspiration, the clinic notified me that the radiologist we working with before we no longer cleared to aspirate non-breast serums and we were scheduled for the same procedure with an Interventional Radiologist in the Chronic Wound department. He was AMAZING. It was clear that he had been trained on abdominal serums and ask all the right questions:
-Did the other Radiologists discuss using an sclerosing agent to try to get the walls of the bursa to adhere to each other?
-Did the other Radiologists discuss placing a drain just after the draining of the seroma?
But by the time we found this Interventional Radiologist, it was clear that the Pseudobursa had fully formed and it was thick and disfiguring even when he drained it fully - diagnosis = "Chronic Seroma with Pseudobursa"

So, we scheduled the Pseudobursa excision with the plastic surgeon and in the outpatient surgicenter and as she removed the Pseudobursa, opening the existing tummy tuck scar, she closed as if she was performing a full tummy tuck. She did an amazing job with both the flap tightening and the suturing close. My wife was fitted with a wide compression band and was asked to wear it continuously and return for follow up checkups every 4 days for 4 visits. My wife was also asked to avoid any lifting and twisting of her waist and remain on bed rest for 2 weeks except for biology breaks to the bathroom and traveling to the Dr for those checkups.
My wife has healed up completely and has the most wonderful and flat tummy that she wanted so bad for so many years,

Hope this experience is useful to someone. If we could turn back time to returning home from the TT. we would have been monitoring for the signs of swelling and sought local medical advice from a local plastic surgeon and would have located an Interventional Radiologist for proactive seroma treatment to avoid having a pseudobursa form around the seroma.

Anonymous said...

Dr. Repta,
Thank you for your informative answers to everyone's concerns. I am 6 wks out from a TT. I am still experiencing what seems to be excessive swelling and the "ken doll" syndrome. I have yet to see a flat tummy and am still unable to wear any of my clothes. My drain slipped out 3 days post op so I did not have successful drainage. I have multiple tender spots and one large sore uncomfortable bulge on the right side from my bb to the pubis that my ps has tried to aspirate on two occasions but was unsuccessful. I am being sent to have an ultrasound next week. How long does it take for your body to form a pseudo bursa from a seroma and how do I know if it is infected? What are the tender spots and should I still be this swollen at 6 weeks?

Dr. Remus Repta said...

Hello Anonymous,
With your drain falling out at 3 days following your tummy tuck we must assume that you developed a seroma. The seroma could have become a pseudobursa, especially if it was not aspirated. Its certainly possible that you have developed a pseduobursa at 6 weeks following your surgery. The tender spots, especially if they are red and worsening could be indicative of an infected pseudobura. If your symptoms are improving its reasonable to wait and see where your final results end up. However, I suspect that your symptoms are not improving. Correction would be best performed through surgery to remove the entire pseuodbursa as well as any foreign suture material.

All the best,

Dr Remus Repta

zoe said...

I had a tummy tuck eight months ago i had several complications after with the scar getting infected now i have a swollen lump just below my breasts and i feel pregnant even though important not it looks like and feels like a baby inside me no doctor seems to know what it is can you shed some light on this please

Dr. Remus Repta said...

Hello Zoe,

There are a few issues that might be occurring. Any fullness or roundness of the abdomen after a tummy tuck must be from one of several sources including pseudobursa, insufficiently tightened abdominal wall, or excess abdominal fat. Excess abdominal fat can be liposuctioned but a pseudobursa or an insufficiently tightened abdominal wall will need to be repaired surgically. The lumps that you describe may be part of the pseudobursa as well. A more detailed discussion will of course be needed to provide a more definitive diagnosis. I am sorry to hear about what you are experiencing. The good news is that there are solutions even if they may require re-doing the tummy tuck procedure.

All the best,

Dr Remus Repta

Anonymous said...

Dear Dr. Repta,

I am so happy to of found your blog and the incredible insight you've provided everyone. I'm hoping you can shed some light on what I'm experiencing.

I had a full tummy tuck w/muscle repair in 2006 w/lipo on my flanks only. PS wouldn't do it on the abdomen during the procedure. (prior 3 c-sections) I recovered for what seemed to be without incident. However, my abdomen has kept a very 'full' appearance since the surgery. I was left with 'dog ears' which I was warned could happen and would warrant an additional surgery to fix. When I returned to the PS to discuss a possible revision, I asked why my abdomen was hurting. It felt very hard and tight. His explanation was that he pulled the skin very tight and basically told me to stop eating.

I was horrified by his treatment of me and so I never went back to him or had this issue addressed. Ever since I've had the surgery, my abdomen seems to swell, more so as the day goes on. I will also develop a charliehorse in my abdomen (wow those are painful) when I turn a certain way. Usually, it will occur when I'm trying to lay back, as if to lay back on an exam table.

I am overweight though my weight has not fluctuated much since the surgery. What would be causing me to look 5 months pregnant with a hard feeling abdomen that gets chronic charliehorses? If you were to push on my stomach, it would bounce back like a trampoline if that makes sense. It's not a typical gushy, fat type of feeling.

I'm not comfortable returning to this PS, whom would I seek an evaluation from? A PS or General Surgeon? Any insight would be so greatly appreciated. Thank you!

Anonymous said...

Hello,
I had my 2nd TT in CA on 11/13 and I have a larger abdomen than before. My drains fell out a couple of times and my PS reinserted them. I had drains for about 5 to 6 weeks then he also inyected and took out fluid about 4 times I went to my Primary care physician and a CT was ordered and it states: Midline colecction measuring 1.2x3.6 cm with peripheral contrast enhancement. finding may be due to cellulitis/abcess. Then I had a U/S and it states Rt lower abdominal quadrant, deep to surgical scar, there is a hypoechoic structure measuring 8.8x2.1x3.8cm Impressins: Hypoechoic structure deep within RT lower abdominalquadrant overlying surgical scar. Rule out mass versus fluid collection versus fibrosis. If clinically waranted. I was told I have to return to PS for any additional F/U. Do you think I have Seroma or Pseudobursa? What do you recomend I do? My P/S wants to Lipo the area again. Please help!

Dr. Remus Repta said...

Hello Anonymous tummy tuck 2006,

I would seek consultation with a plastic surgeon. It will be a plastic surgeon that will be able to best diagnose you and repair any issues that you may have. The dog ears are easily corrected either under local anesthesia or with IV sedation. The fullness and bloating that your describe will require a more in-depth evaluation. You and the plastic surgeon that you choose will have to determine if the fullness is from seroma/pseudobursa, from the abdominal wall tightening that was performed, or from an intra-abdominal process that contribute to abdominal distension. Seek several consultations with board certified plastic surgeons to get as much guidance as possible.
All the best,
Dr Remus Repta

Dr. Remus Repta said...

Hello Anonymous tummy tuck "11/13"

I am assuming you had your second tummy tuck on Nov. 2012. It certainly sounds like you had some issues with your drains and at the time of your studies there was evidence of a seroma. There is a good chance that the seroma has been encapsulated and now is a pseudobursa. Liposuction will not correct a pseudobursa as it is thick scar tissue. The best course of action if there is a pseudobursa is often to remove it directly. The pseudobursa is large or extends far up the abdomen a full tummy tuck revision is often needed. The time and money invested in this is more than just liposuction but in the long run it will be the best way to go.
All the best,
Dr Remus Repta

Anonymous said...

Thank you so much for taking the time to reply Dr. Repta. While I'm searching for a new PS, I have an appt with my primary care for my annual physical. Would an ultrasound show a seroma/pseudobursa?

Thank you (TT 2006)

Dr. Remus Repta said...

Hello TT 2006,

My pleasure. An ultrasound may show a pseudobursa if it is thick enough and/or has some residual seroma fluid in it. It is not a bad place to start. The history and physical are often the most important. Only a few of my patients ever come in with ultrasound or CT scans showing a pseudobursa and thus far when I have considered the presence of a pseudobursa based on the history and physical exam I have never not encountered it during surgery.

All the best,

Dr Remus Repta

Andreamax said...

Thank you so much for posting all this great advice. I wish I had found this blog months ago. I had a tummy tuck 10/12 and everything was fine until January when I stopped wearing my compression garment all the time. I got a wave like feeling in my lower abdomin. I went to my ps and he said it was a seroma. He tried to drain it but had no luck after trying 3 different spots. He then scheduled another appointment for me to get a local and try to drain it that way. He had to cut very deep almost to my pelvic bone before he was able to get some fluid. He was able to drain 300 cc but when I stood up there was still fluid. He then told me to wear my compression garment again 24/7 except for showering. Well after that whenever I would eat my upper stomach would swell and I would break into a cold sweat. I stopped wearing the compression garment because the fluid was going into my muns which I had also tightened and going up to create a muffin top below my breast. I insisted on a ct scan as I was not satisfied with the seroma will eventually absorb as he could not get to it and he did not see a bulge. He kept saying my stomach was as flat as a board but I couldn't fit any of my clothes and a hard bulge was present especially after eating or doing anything strenuous. The ct showed I had 2 seromas that stretched from hip to front on each side and was 11 cm by 10 cm and 2 cm thick. They moved so they were not incapsulated. It also said I had a umbilical hernia. Well my ps was very upset and said report was wrong I did not have a hernia thAt is how he does his belly buttons. He then went on a tyraid about how he has never had an unsatified patient and I should go get another opinion if I didn't believe him. I began to cry and told him I just wanted to get rid of the lump and it was embarrassing looking like I was six months pregnant right after I paid thousands for a tummy tuck. I then made an appointment with my primary (who had referred me to the ps) he said I would get a surgery to drain the seromas and retighten the muscles and an antibiotic would be placed to close the dead space as he called it. Well in the meantime my CBC levels have been all out of wack and I have not been able to have bowel movements. My primary wanted to get my anemia up before I did the seroma surgery. Anyways I finally got the seroma surgery on last Friday with my ps as I felt I paid a lot of money and he should fix it as he took my drains out even though I was still draining over 50cc a day after the surgery. I went on a major diet and lost 20lbs as I wanted to make sure it was not fat and he would have more skin to pull. Well today he took off the bandages and compression garment and I had blisters all over the incisions. Once again he said this has never happened to him. He said when he opened me up there was no fluid but he found the capsule and cleaned it out. Now have no clue what to do. My left side of my abdomin still feels hard to the touch and now I have these painful blisters that he said will heal just keep them cleaned and covered and keep wearing my compression garment. I am at a loss for what to do. I don't know if I'm allergic to the sutures or tape. He said he does not know why I blistered he busted 2 of them and a clear yellowish liquid came out. He decided not to bust the other 6 we saw. I went to change my dressing tonight and now they are bloody and it looks like I am getting the blisters under the incision as well. Any advice would be greatly appreciated. I feel like I made a horrible mistake in getting a tummy tuck as I have had nothing but problems health wise since.

Thanks,

Wish I never had a tummy tuck

Dr. Remus Repta said...

Hello Andreamax,

I am sorry to hear about your experience. The incision line blisters can be from a number of reasons and often they are minor and without long term consequences. Often the combination of tightly adherent skin tape together with skin degreaser (mastisol) and the swelling process following a tummy tuck results in skin blistering. The good news is that if this are is treated with antibiotic ointment and non-stick gauze it will heal and most often not leave any issues for the long term.

The swelling and bloating that you have described is almost certainly a pseudobursa. I do not know if your plastic surgeon removed both layers of the pseudobursa when he went back in but I have found doing so to be the best solution. At this time I would give your body a chance to heal and then you can re-assess later what if anything needs to be done. You should keep the drains in a good amount of time and wear your abdominal binder snuggly essentially around the clock.

I hope this helps.

All the best,

Dr Remus Repta

Anonymous said...

Hello Dr. Repta,
Thanks in advance for your time in responding to my questions. My circumstance is not as upsetting as many others, but I would like to hear your thoughts on my situation.

In March of 2012 I had a full TT and lipo of the abdominal area as well as back and flanks. All went well; I'm a fast healer and had no serious issues. A fluid pocket did develop within a few weeks and the Dr drained it a couple of times with no long term complications.

Now fast forward to mid-February 2013... I was leaning against a high coutertop and felt a hard lump an inch or two above my belly button slightly to the left of center; the size is approx. 2" long by 1-1.25" wide and maybe 1/2" thick. Please note this is not the area where the fluid was previously drained shortly after surgery and I had not noticed any swelling or hardness prior to that day in February. There is no pain and the size has only seemed a bit thinner on occasion, however that could be my perception rather than fact. I visited my PS a week after my discovery and he sent me for a CT scan. The CT showed an encapsulated pocket of fluid that has deveoped a hardened shell; Seroma/Pseudo-bursa (not sure of the difference). The PS's plan is to use lipo to "remove" the PB during a visit when he will be doing some in-office touch-up lipo on areas that need a bit more fat removed, sometime in the next 14-30 days.

My question to you is will using lipo to remove the PB be a waste of time? Should I request that he remove the seroma directly via an incision over the PB (as it's not near the original TT incision)? And if so, is this something that is typically and safely done using local anesthetic in the PS's office?

Thanks again for your time,
SB in IA

Dr. Remus Repta said...

Hello SB,

There is really on two reasons to remove a pseudobursa. Pain or contour irregularity. There is an argument to be made about a third reason of palpability (being able to feel the pseudobursa even though it does not cause pain nor contour irregularity. Liposuction will thin the fat above the pseudobursa and will therefore address the second issue since it reduces the fat in that area and camouflages the contour irregularity. It will not likely make much of a difference with the pseudobursa itself so if it is causing pain it will not be a solution. It may also make feeling the pseudobursa better for the reason stated above. If you are going to have some touch up lipo it makes sense to have some lipo done in that area as well. A pseudobursa can be removed via a new incision, the low horizontal pubic line incision from the tummy tuck, or through the belly button. Which incision should be used will depend on a discussion and examination with your plastic surgeon.

All the best,

Dr. Remus Repta
Phoenix/Scottsdale, AZ

Anonymous said...

I have a question - I am 51 and had a tummy tuck last December (8 months ago). I went to have some excess skin removed after four pregnancies). After 8 months, I still have an area around my belly button gets very hard and looks swollen as the day goes on. When I saw my plastic surgeon, he said that's as flat as it's going to get. Is this normal? I really don't have any pain but I feel like my stomach still hangs over my pants when I sit down. I also still wear the same size pants as I did before the surgery which seems odd to me. Any comments/suggestions? Thank you!

Dr. Remus Repta said...

Hello Anonymous,

Swelling after a tummy tuck is normal as you may imagine. It takes quite a while for the swelling to go away. At 8 months I would imagine that most of the swelling, perhaps not all, has gone away. Fullness around the belly button that gets worse through out the day may indicate either residual healing that has to occur, an abdominal wall that needs additional tightening, or a pseudobursa. If there is extra residual skin that needs to be removed this can be removed as a revision tummy tuck or as part of a full tummy tuck redo. If you would like you can contact my office and they can guide you through the process of emailing photos as well as setting up a phone consultation.

drrepta.com

All the best,

Dr. Remus Repta

Anonymous said...

Hello Dr. Repta

I recently had abdominoplasty to correct my birth defect(gastrochisis).

2 weeks post op I had a seroma & I had it drained twice. There was a small remaining amount of fluid that my surgeon advised would go away on it's own (he couldn't drain it with the needle).

I am now nearly 4 months post op and the area on the upper right abdominal wall where the seroma was is more raised then the left hand side. But, I can also pinch more skin on this side where the seroma was. This area also feels more hard then the left hand side & like something is bulging it's not soft and tight feeling like the left hand side.

Unfortunately, I had my surgery done in the US and I am in Aus - I had to travel because no surgeon here thought a tummy tuck would correct my gastrochisis - which it did completely but now I only have this minor issue. It is not a overly noticeable contour irregularity & much better then what I had before but it still bothers me because I never had fat/bulges in this area pre-op - I only weigh about 55kg and am 167cm tall. I am just worried now of the extra expenses I will incur... if it is a Pseudobursa - is this costly to remove or is it a in office procedure?


Thanks

khodson24 said...

I had my TT an hernia repair in March 2012 and I have the exact same thing you are describing. I am having to have it completely redone but my surgeon is waiving his costs but I will have to pay for the surgery center and anesthesia. Good luck but it sounds like you will have to have a revisional TT. I had 3 other 2nd opinions and they all said the same thing.

Anonymous said...

Aaah thanks for your honesty, I really hope I don't have to do that because it would be so expensive to do all over again :(

For Dr.Repta - I have an update...
I had an ultrasound yesterday late afternoon and the lady said the areas that are inflamed I do have pockets of fluid still there... she said the one on the lower left abdomen is resolving and the one on the upper right abdomen is so small no one would put a needle in it... which is why my surgeon left it after he drained as much as he could I guess... I am only 4 months post op & she said seromas can last a very long time so mabye this will even out? what do you think?


Anonymous said...

Khodsen24 - what did they say it was in your abdominal wall that you had to get the whole procedure re-done? As I mentioned in my previous comment the ultrasound shows small amts of fluid still present but these either subside on there own or form scar tissue so having the whole abdominoplasty procedure again seems excessive?

Dr. Remus Repta said...

Hello Anonymous,

At 4 months there is still time in your recovery for the seroma and potential pseudobursa to improve. Once the body has dealt with the seroma it may very well begin to remodel some of the collagen in the pseudobursa. If this occurs some of the minor issues that you are describing will improve.

At this time I see no harm in waiting and seeing how your body reacts. You may try and continue to wear an abdominal binder for the time being which may also help.

If the problem does not improve with time your options will be to either camoflouge it with a little liposuction or by removing it completely via a complete tummy tuck revision. It will make more sense to you when the time comes which path to take. For now, it sees like you are enjoying the improvement that your tummy tuck has provided.

All the best,
Dr. Remus Repta
http://drrepta.com

Anonymous said...

Hello Dr.Repta

Thanks so much for replying. I do have a few more questions if you wouldn't mind... If there will be an improvement, at what time frame will I see the improvement (6 mths, 1 yr etc...?)

To perform a tummy tuck revision to remove a Pseudo-bursa would that be the same price as a normal tummy tuck?

Thanks again

khodson24 said...

Nothing is showing in my ultrasounds or CT except for swelling. He said he would need to raise the skin up and expose the whole abdomen to see what really is going on. He thinks the sutures have tore through b/c I was dropped on my back at the hospital and I felt my sutures rear through. It was the worst pain Inhave ever experienced. I had to have fluid taken out by a needle once after surgery. My upper right part of my belly is awful!!!! Hopefully yours won't be as bad;)

Dr. Remus Repta said...

Hello Anonymous,

If the irregularity is not that bad I would give it 8-12 months to see what happens. You will be able to see along the way if progress is being made. Massage and abdominal binder use can help.

Since your irregularity is above the belly button I suspect your tummy tuck revision will be similar in price to the original tummy tuck price. I have found in my experience of doing revision tummy tuck surgery that getting everything taken care of to the best possible amount is often the best decision as opposed to a lesser procedure to try and save time and/or money.

All the best,
Dr. Remus Repta
http://drrepta.com

Anonymous said...

Hello Dr. Repta,
I had a seroma around 2 weeks post full TT after having my drains out. My two drains were in place for 10 days. The seroma resolved well after about 5 daily aspirations and I went on my merry way from weeks 3-7. Then at 7 weeks after a few days of heavier activity (beginning moderate exercise) I developed a larger seroma. I have been having it aspirated daily for a week now and it is resolving - today it only produced about 10cc fluid after the initial aspiration of 150cc. The area feels very firm to me and my PS mentioned that it could be from the lining of the seroma and if that it doesn't resolve she may need to go back in and remove it. My question is, would it be too soon for a psudobursa to be forming? I am now 8 weeks out. I was under the impression that being very on top of draining seromas daily (which my PS did) would prevent this from happening. THANK YOU so much for your input.

Anonymous said...

I had an abdomenoplasty almost 5 years ago. Seven months after the surgery I noted a lump under the umbilicus and increased pain. My symptoms are tightness rt. side like strings are pulled too tight, also my lowest rib hurts, I cannot take a full deep breath without pain and I only have relief for a few minutes upon waking in the am. I have seen 11 assorted MD's the latest being a radiologist who injected a neuroma he said he saw. There was no improvement with that. I just don't know what to do. Pain pills don't help.

khodson24 said...

I just recently had revision all surgery from my TT in March 2012. I experienced the same pain you described. My surgeon found my sutures had criss crossed in the tissue and I was allergic to the permanent sutures so he replaced them with 3 month dissolvable sutures. He also had to repair my right side where my tissues had tore. I am finally out of pain! Having the revision all was the best decision I've ever made. My surgeon didn't charge me a surgeons fee;) You may need revisional.

Dr. Remus Repta said...

Hello Dec 3rd Anonymous,

Sorry for the late reply. It sounds like your plastic surgeon has done a great job in taking care of you. A thin pseudo-bursa may not become much of an issue. At this time I would continue with the "wait and see" process. Chances are you will be ok as the seroma has been taken care of along the way.

All the best,

Dr. Remus Repta

Dr. Remus Repta said...

Hello Dec 29th Anonymous,

Thank you for the question. I am sorry to hear about your experience and your struggle with symptoms of pain and tightness. At some point when symptoms do not subside and no answer or treatment seems available surgical exploration can be the right choice. Whether its a pseudo-bursa, suture material, or something else, surgical exploration can help diagnose the treat the problem.

All the best,

Dr. Remus Repta

Lee said...

Hi,
I had a tummy tuck over 2 years ago and have what I believe is a pseudobursa along most of my left side. I have been back to my doctor and he has injected it with some thing to break down the scar tissue as well as do a small fat transfer to break some of the skin away from the abdominal wall. That is all he said he could do and has pretty much blown my off. My sides is very painful yet numb and tingly to the touch?? Do you know of a good plastic surgeon in utah?

Dr. Remus Repta said...

Hello Lee,

I'm sorry to hear about your experience and symptoms. I've started posting replies on my new blog designated for my tummy tuck site. Here is the link to your answer:

http://www.scottsdaletummytuck.com/blog/?p=160&preview=true

All the best,

Dr. Remus Repta

Anonymous said...

Dr. Repta~

I am hoping you can help me! I had a TT with MR, lip and a breast reduction 2 years ago. I had the pseudobursa, I believe, in the form of an uneven hard uncomfortable mass at my horizontal incision. My PS agreed it was scar tissue most likely that needed to be removed, which we did just 15 days ago. I did not have a drain afterwards, to my surprise. The site looked and felt much better the first few days. I faithfully have been wearing my binder, except when massaging, etc. I know have developed an even harder and larger mass in the same area that he cleaned out the scar tissue (with lipo). It is not the normal swelling. It is hard, running about 3-4 inches along the incision line, and is very uncomfortable again!! Please help! Is this another pseudobursa again already, or is there ANYTHING I can do to prevent it, or break it up? It has only be 15 days, and I do not want to ever go thru another surgery for it again! I go see my PS again today, but here he just fixed the last one, and I'm afraid of what he will say. Thanks for all your help!

~M

Anonymous said...

Dr. Repta,

My Tummy Tuck was a year and a half ago. I began to have upper abdominal buldging shortly after surgery that has never gone away. It gets worse as the day goes on. It looks like I have a tire around my upper belly, it's completely embarassing and uncomfortable. Below my belly button is flat, but then where my incision is, my belly goes from flat to concave.

2 months ago, my PS did liposuction on the upper part of my belly. It looked great for about 2 weeks, now it's back to the upper abdominal bulding.

I can feel a hard lump right above my belly button, this started after the lipo procedure.

Is it possible that the bulding issue could be a pseudobura? Or is the upper abdominal bulding going to be there forever...

Remus Repta said...

Hello Anonymous,

Please see my reply at the link below at my new blog on my tummy tuck website.

http://www.scottsdaletummytuck.com/blog/wp-admin/post.php?post=178&action=edit&message=6

All the best,

Remus

Anonymous said...

I have a huge bulge under my ribs/above my bb that causes deformity and makes me look 5 months pregnant. Its very hard. At times I am in great deal of pain and believe its from this. It changes in size. Could it be Pseudobursa? I had full TT done 18 months ago. I am assuming it wont be able to be aspirated? The general surgeon I seen wanted to cut my stomach where the bulge is and clean it out? Is this the only option I have? I am very unhappy with my results, what I am wondering is if I do a revision can this removed at this time?

Remus Repta said...

Dear Anonymous,

Please see the link below for my reply to your questions.

All the best,

Dr. Remus Repta

http://www.scottsdaletummytuck.com/blog/pseudobursa/217/

SM EAST BAY said...

Dr. Repta
I am just at 5 months post-op from my Tummy tuck +. I did a lot in my surgery (Nipple lift-augmentation (smallest size available), tummy tuck along with flank lipo & lipo of my outer thighs.). My Dr. is Highly rated & loved. He has his own surgical center - attached to a hospital. Sanitation procedures before surgery where intense (washed with wash they provided before surgery, no products, was given a iodine sponging from head to toe and had to get myself onto the thickly lined table while touching Nothing but the blue sheeting. I did everything I was told - walking, binders, etc., I seemed to be healing well, body looked good except for the bruising - I was out of it and in lots of pain (could never take the meds). My tummy, belly button & breast incisions healed great, but my lipo seemed to heal and then at about 2 months they got red and pussy again. Had two cycles of Keflex (1 before/just after surgery), did not work so was changed to Ciprofloxacin by plastic surgeon as well as my primary care (he suggested I get a culture). It did take care of the pussing and they incisions did finally close and are 'healed'. But sometimes they still itch, and they have a thickness under them (like an absess feels). I never had a fever, but they still will get itchy and reddish and warm. Ironic I was writing this mainly because of my belly issue, but this issue concerns me too, after reading some of this post, because my belly at that point, seemed swollen. I pointed it out to the Dr., and he said it is most likely some fat he could not get to- and I could lipo later - he did ask about my weight gain, but I have not gained any weight - my belly extends out, the belly incision line is quite a bit in, and if I tuck really tight my belly looks more flat and much more appealing to me - I hate to say it, because of his reputation and ethics, but it seems like he didn't tighten the muscle enough or something. I mean at the 2-5 month, could I have a loosening of the muscles? Can I cure this with exercise? (I have a back injury so that is difficult). When I read your post, I saw that sometimes Pseudobursa can have oosing? But my oosing was not in my tummy, but in my lipo incisions on my high hips just under the tummy tuck incision. Another point worth mentioning, is that my tummy is still very very tight, my flanks JUST woke up a few weeks ago (which I was told could happen), and my tummy is still numb down the center, I can only feel INSIDE my belly button. But my incision and center tummy are still very very tight, and very sore. The doctor has said this can be very normal. I only have 7 months of corrective rights under our contract, and I have a wedding in 9 months. Would you please provide some insight into my situation. I do not like my plump (it does push, it is not tight) tummy, or the infection connection to it. Just want to be sure I come to him with questions. I actually have my 3 month appointment in a couple days. I appreciate any onsite you can provide. Thank you! :)

Remus Repta said...

Dear SM East Bay,

Thank you for the question. Please see my response to your post at my new blog. I have placed a link to my response below.

http://www.scottsdaletummytuck.com/blog/dr-repta/dear-sm-east-bay-tummy-tuck-results-question/

All the best,

Dr. Remus Repta

Anonymous said...

Dear Dr Repta
Hi, I had liposuction on my upper arms a year ago.
I complained about constant fluid leakage and the doctor said it was so called seroma. He aspirated seroma two times after the surgery. But the symptoms were existed. I went to the doctor and complained about it,
however, he said it's better to leave it alone so the fluid can be absored. So I waited for 1 year and now I feel some kind of fibrous tissure around bulging area. I also feel some sensation loss on that area too. I told my symptoms to another doctors and they treated me like I was faking.
I think they don't understand this side effect after lipo because its extremely rare. I understand there are some treatments exist including the excision surgery. But I don't want to have large scar on my upper arm. Is it possible to remove pseudobursa on upper arms without leaving any significant scars?

Anonymous said...

Had a panniculectomy about 10 yrs ago. An artificial navel opening was created over my exising belly button which was 1-2 inches down and inside the artificial navel opening. Problem over time the skin around the artificial navel has become hard and will not stretch, so I cannot clean my real belly button and it stinks. No one wants to help me open the artificial navel open that has all but closed. When i squirt peroxide inside the cavity to clean it it foams. What can I do?

Remus Repta said...

Dear Anonymous (belly button issues after abdominoplasty/panniculectomy):

Thank you for your question. I have posted a reply to your question at the link below on my new blog:

http://www.scottsdaletummytuck.com/blog/wp-admin/post.php?post=258&action=edit&message=6

All the best,

Dr. Repta

Anonymous said...

I had a full tummy tuck 2 years ago with 1 seroma drained twice. A year ago my tummy started feeling really tight beneath my bb, it feels tight and pulls and feels very uncomfortable . I had a scan and a 33x6 mm seroma. It's very small so why is it a much bigger area that feels so very uncomfortable, it's Fromm my bb and travels over the the right side and sometimes above my bb ? And what should be done ???

Remus Repta said...

Dear Anonymous,

Thank you for the question. I have replied with an answer and short video clip on my new blog site. The link to my reply is shown below.

http://www.scottsdaletummytuck.com/blog/phoenix-plastic-surgery/dr-repta-answers-a-question-about-pseduo-bursa-after-tummy-tuck-surgery/

Thank you