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
Question HI DR E,
i HAD AN EXTENDED TUMMY 3 MONTHS AGO AND HAVING TROUBLE WITH A SEROMA. EVERY 2 WEEKS i have ultrasound assisted drainage and the fluid keeps increasing. There is no pain just very uncomfortable. Is there anyway of detecting a pseudobursa by MRI or ultrasound. I also have Rheumatoid arthritis and have had 2 previous bursas removed from the elbows. Any relation to the present problem?
Answer Hi Anitra,
I'm sorry for the problems you're having.
I have had much better experience treating fluid accumulations with the reinsertion of drains than with periodic aspirations. I have actually written a lot about this for allexperts: if you do a search for "Engler seroma" you'll see 148 answers, and "Engler pseudobursa" will give 30 or so.
I would recommend the insertion of two good drains that provide constant, complete drainage. Aspirating does not, in my experience, fully evacuate the cavity, and doing it only every two weeks allows it to reaccumulate.
In fact, I am concerned that, at this point, you could be developing, or have, a pseudobursa. Once this scar tissue forms, you may well need an additional procedure or surgery to get rid of it. That can actually be determined by, among other methods, injecting some dye into the space. I would urge you to try to get some drains inserted.
Finally, though this is outside my area of expertise, the mechanism of rheumatoid arthritis joint problems, including bursae and bursitis, appears to be different from what's happening here. However, it is certainly possible that your RA has made you more likely to develop the fluid problem you're having with your TT. I would advise you to speak to whomever is taking care of your RA about this and there may, in fact, be a link.
