AboutAlan M. Engler, MD, FACS Expertise Dr. Engler has answered over 2700 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.
Education/Credentials Dr. Engler graduated from Yale University (undergraduate) and the College of Physicians and Surgeons of Columbia University (medical school). He did his residency training in General Surgery and, after that, Plastic Surgery, at the Montefiore Medical Center in New York. He is on the faculty of the Albert Einstein College of Medicine in New York.
Question I am just under one year post tummy tuck. I've had an area of swelling in the upper right quadrant of my abdomen since about three weeks post-op. My drains were kept in place for two weeks. When I mentioned this area of protuberance to my surgeon his comment was that he had made sure everything was put back in its place and that was it. Nothing was ever mentioned about a possible seroma.
I had an area of delayed healing about midway on the lower abdominal incision that persisted with drainage for four months post-operative until the surgeon did a scar revision surgery which closed up the still open wound. I had an infection two months post-operatively which resolved with antibiotics. Again, nothing was mentioned about a seroma.
Immediately after the revision surgery the lower incision especially in the place of the open wound felt better, but the site of the swelling in the RU quadrant was the same.
I should have been more proactive in pursuing the swelling, but I had chosen to have my surgery in a city around an hour and a half drive one way from my home. I rigorously followed my post-op visits throughout the summer and early fall, but with my job in jewelry sales time eventually got away from me and with the holiday season shortly in full swing, I was unable to easily return for further follow up.
Every night I need to place an icepack over the swollen area and in the morning it usually doesn't feel as swollen and painful.
There have been several traumatic emotional situations that I've dealt with since my surgery in May of 2008, which is just to say that I've been pulled in a variety of different directions. Unfortunately, I've been distracted from taking care of this sooner.
In my ignorance, and with the doctor not indicating otherwise, I naively assumed that this was part of the healing that could take several months. It has been a persistent problem, which I am now diligently pursuing.
I've had a abdominal/pelvic CAT scan within the past week which shows a couple of sites of fluid collection. Interestingly, it didn't indicate fluid in the area that I have my complaints.
I did see a plastic surgeon today for a consult regarding this issue. She palpated the area and with a visual examination of the upper abdomen found what she feels could be a seroma. I can feel this "lump" in the upper right quadrant each and every day.
She explained in great detail the possibility of this being a seroma and what my options are for getting this issue resolved. I would like to know what your suggestions would be to treat this at almost one year post-op?
I'm somewhat hesitant to return to the surgeon who did the surgery, because of his disregard of something that is now proving to be extremely painful and intrusive into my everyday life. I'm fully aware that insurance will not cover this procedure in any way, shape or form, whether it be aspiration, placement of a drain or surgical excision of the seroma.
How many second opinions would you recommend, or should I make the decision to follow through with this surgeon in the immediate future? I know that this is really a personal opinion, but will I get a different opinion from other surgeons to make this stressful situation even more stressful? I'm ready to feel "normal" again and to get back to life.
I apologize if this has been long and rambling, but there is a lot of pent up frustration in my letter to you. I am very grateful for your opinion, and I thank you very much for this service. I look forward to hearing from you, hopefully in the near future.
Most Sincerely,
Holly
I've been diagnosed with GERD in the past couple of weeks by my internist.
Answer from Dr. Alan Engler
www.bodysculpture.com
Hi Holly,
I'm really sorry for the problems you've been having.
I'm a little surprised that the CT Scan showed any fluid collection at all at this point, since it's usually resolved or gotten clearly worse. But the fact that there wasn't any fluid in the area in which you have the symptoms is also hard to explain - why do you think it is fluid, rather than some persistent fat that could just be lipo-ed out? If it's not fluid on the CT, then you can't necessarily assume it's a seroma. The easy way to find out is to have your surgeon insert a small needle into the mass (as long as he/she is sure it's not intra-abdominal!) and see if fluid comes out. If it does, it may be a long-standing seroma; if not, it's most likely not.
You might as well see 1 or 2 more nearby surgeons and then, based on what they say, you'll have to make a decision on what to do. I'm not sure that I can be any more specific than that, in view of the complicated history and my inability to examine you in person.
That being said, I hope that this helps, and good luck,
