A seroma is a pocket of clear fluid that sometimes develops after surgery. Think of when you scrape your knee — the raw area oozes fluid as it heals. After surgery, especially when skin flaps are lifted or moved, the body reacts in a similar way. The space left behind under the skin can collect this fluid, forming a seroma.
While seromas are usually harmless, they can cause swelling, tenderness, or slow the healing process if not managed properly.
Why Do Seromas Form?
Seromas form because the body is trying to heal. However, several factors make them more likely:
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Tissue trauma: Surgery creates raw, healing surfaces that naturally release fluid.
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Dead space: When skin or tissue is lifted, it leaves a pocket where fluid can easily gather.
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Interrupted lymphatic flow: The normal drainage system is temporarily disrupted during healing.
Traditionally, surgeons have placed drains to remove this fluid and lower the risk of seroma formation. While effective, drains can be uncomfortable, limit mobility, and cause anxiety for patients.
Quilting Sutures: A Modern Approach
At Oregon Cosmetic and Reconstructive Clinic, I’ve used quilting sutures for nearly 15 years as a more comfortable, effective alternative.
Here’s how they work:
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Internal sutures hold layers together: I place dissolving sutures inside the surgical site.
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Tissue surfaces bond naturally: As the layers stay in close contact, the raw surfaces “stick” together.
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No space for fluid: Because the space closes, there’s nowhere for fluid to collect.
When I first started using this method during breast surgery, I continued to use drains as a backup. However, I soon noticed that very little fluid was actually draining. This observation proved that the quilting sutures were doing their job — and drains were often unnecessary.
Evidence Supporting Quilting Sutures
Scientific studies support this approach as well. A large double-blinded randomized control trial from the Netherlands studied over 300 patients who underwent mastectomy. The researchers compared those who received no quilting sutures versus those who had flap fixation (another term for quilting sutures).
Their findings were clear:
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Patients with quilting sutures had a much lower incidence of seromas.
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There was no increase in complication rates, including post-surgical discomfort or infection.
In other words, quilting sutures not only reduced fluid buildup but also maintained a safe, smooth recovery process.
Because of this evidence — and consistent results in my own practice — I now perform many surgeries without drains, using quilting sutures alone.
What This Means for Patients
Switching to quilting sutures makes recovery smoother and less stressful for patients.
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Less discomfort: You avoid having drain tubes placed and removed.
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Faster recovery: With fewer fluid collections, the body can heal more efficiently.
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Lower anxiety: You can focus on healing without worrying about drain care.
This technique has become especially valuable in breast surgery, but it can also improve results in other procedures involving tissue flaps. Learn more about breast procedures where this technique is used.
Summary:
A seroma is a natural but sometimes troublesome fluid buildup after surgery. By using quilting sutures, I help the body heal more efficiently — without the need for drains. This advanced technique at Oregon Cosmetic and Reconstructive Clinic creates a more comfortable, confident recovery experience for patients.
