AboutAlan M. Engler, MD, FACS Expertise Dr. Engler has answered over 2300 plastic surgery questions for Allexperts. His expertise is in cosmetic plastic surgery including breast surgery (breast enlargement with implants, breast reduction, breast lifts), liposuction, eyelid surgery, tummy tucks, facelifts etc.
Dr. Engler has been listed as one New York`s Top Doctors, and as "One of the World's Most Famous Aesthetic Surgeons" (Aesthetic Surgery, TASCHEN Books, Angelika Taschen, Editor). He is the author of 4 books, including "BodySculpture" (a best-selling plastic surgery book on breast surgery, liposuction and tummy tucks), "EyeScapes" (Plastic Surgery of the Eyelids), "Restylane," and "The Slim Book of Liposuction."
Dr. Engler has two US Patents for surgical instruments that he's designed, and has appeared on numerous television shows, including The Tyra Banks Show, The Ricki Lake Show (four times), and the Dr. Keith Ablow Show. Videos of his appearances are available on YouTube (SEARCH FOR "DR. ENGLER"). His website is www.bodysculpture.com.
Experience Dr. Alan Engler is a board-certified plastic surgeon in New York and the author of BodySculpture - Plastic Surgery of the Body for Men and Women (ISBN 0966382749) one of the top-selling plastic surgery books on amazon.com, barnesandnoble.com, etc.
Organizations belong to ASAPS (American Society for Aesthetic Plastic Surgery); ASPS (American Society of Plastic Surgeons); ACS (American College of Surgeons); Clinical Assistant Professor of Plastic Surgery at the Albert Einstein College of Medicine in New York
I developed a pseudobursa in my abdomen after DIEP flap breast reconstruction. It was removed a few months later by a different surgeon, and at the same time, muscle plication and some lipo were done. Now I believe I have another pseudobursa, above my belly button. When I wear snug pants, a lot of swelling is pushed up into that area that makes the situation more uncomfortable, but there is always a firm area about the size of an egg that doesn't go away. Three weeks ago, my surgeon tried to suck out the scar tissue with a lipo cannula, and things seemed better for the two weeks that I was wearing a compression girdle, but now I believe the pseudobursa is back and will require removal. My question is whether you think that massaging would be helpful--gentle or vigorous---in reducing the growth of the scar tissue, or if it would cause an increase in fluid production and should be avoided. If it has to be removed surgically, I'll probably wait a few months because my abdominal has already been opened three times in the past nine months and I am tired of being in continuous surgical recovery. If there is a way to massage this thing away, I'd like to try that first before having the entire flap relifted again. There is not a lot of information on the internet about pseudobursas. Do they show up on ultrasound or MRI? Thanks for the service you provide by answering questions!
Answer Hi Sandy,
I'm sorry for the problems you're having.
I do not have extensive experience treating pseudobursas, and none following a DIEP, so you'll have to keep my answer in that perspective.
You may well require another procedure to get rid of this pseudobursa, particularly since the first procedure was so successful. I think there are a few other things you can try, but I don't believe that massage is one of them. It certainly won't hurt to give it a try, but it doesn't make sense that it would work, especially if that's all you do.
The first thing is to make sure it's a fluid collection, and not just diffuse swelling (in which case it should get better on its own). You can be examined non-invasively with an ultrasound and/or CT Scan or MRI, and those test should give you a reasonably good view.
If you do have a collection, you could try at least two other things before proceeding to surgery:
1) Have a drain inserted via ultrasound. They can put in a thin tube that will provide dependent drainage and, combined with compression, that may allow the edges of the scar tissue (the walls of the pseudobursa) to stick to each other and occlude the space. As long as fluid cannot collect it doesn't really matter if you have all the scar tissue out or not.
2) There is a way to sclerose the pseudobursa walls chemically. This was done in olden times for chest wall cavities, and I don't know that anyone would be comfortable doing it in the region of a DIEP - so you'll have to talk to your PS about this - but by injecting a tetracycline solution, you can cause a chemical reaction that causes the edges to stick to each other. The one time I did this it was fairly painful - but it worked. Again, I'm not recommending that necessarily, but it is one approach that might save you from another surgical procedure.
Other than that, though, I'm not sure what to suggest...
