A New Complication

[ElbowRoom]

Just when the hematoma I developed post-op is nearly resolved, and everything has been going well, at 12 weeks I have developed a new complication. The symptoms are a painless swelling beneath the incision (which is very well healed), which feels fluid-filled. It seems to come and go, and is sometimes very pronounced, raising maybe a half inch above the surrounding tissue and maybe 1.5” in diameter.

I finally had to admit this isn’t normal post-op swelling, and went in yesterday to see Hakky. He diagnosed, and confirmed with ultrasound, that I have a seroma. This is a pocket of clear fluid that can develop under and incision from surgical trauma to lymph vessels. It’s relatively benign, but won’t resolve on its own. He agreed there is no sign of infection, and we discussed and developed a plan to deal with it:

On Feb 4, he’s going to use a needle to aspirate and drain off the fluid, which he will send off to culture. If the culture comes back positive, or the seroma recurs after draining (Hakky said 10-20% chance of recurrence, my research says more like 50/50, but he’s the expert), then he want to address it surgically, making a tiny incision and cleaning out the space and filling it it with Vancomycin.

The problem with the surgical option is that the seroma lies somewhat close to the tubing and pump, 7.7mm away at the closest point. If the implant is damaged during the procedure, it converts to an immediate rip-and-replace revision surgery. The seroma surgery carries a 1% risk of infection, which rises to the normal 3% for a revision if revision is required.

This is pretty terrifying, especially considering that other than this fluid pocket everything is going well, the implant works great, and I’m very satisfied with the result. I don’t want to go through the entire surgical recovery again!

I’m hopeful that the needle takes care of it without need for further action, but that’s not how my luck usually runs. If you’re the praying type, please toss one my way for a quick and easy resolution to this issue.