Seroma after cosmetic surgery: a mini-systematic review and evidence round-up from PubMed meta-analyses

How the evidence was selected: Criteria for the latest PubMed evidence

A targeted PubMed search strategy was used to identify systematic reviews and meta-analyses focused on seroma after cosmetic surgery. Because the literature is not evenly distributed across all aesthetic procedures, priority was given to pooled analyses directly examining abdominoplasty, body contouring, and seroma-prevention strategies. The final evidence set comprises five PubMed-indexed meta-analytic papers published between 2021 and 2025: a 2025 review with meta-analysis on preventive strategies in abdominoplasty, two 2024 meta-analyses on seroma prevention, a 2021 meta-analysis on global seroma prevalence after abdominoplasty, and a 2021 meta-analysis on complications in postbariatric body contouring.

Incidence of seroma after cosmetic surgery: Where the pooled signal is strongest

The strongest pooled incidence data come from abdominoplasty, where seroma is repeatedly identified as a leading postoperative complication. The 2021 meta-analysis by Salari explicitly aimed to standardize the global prevalence of seroma after abdominoplasty, confirming that seroma is common enough to be a major clinical issue rather than a minor or occasional event.

That signal is reinforced by broader body-contouring evidence. In the 2021 meta-analysis by Marouf on postbariatric body-contouring surgery, seroma was the most frequent pooled complication, reported at roughly 12.7%–13.9% across body regions. This is highly relevant to cosmetic surgery because it shows that seroma is not only a technical nuisance after abdominal contouring, but a dominant complication signal in larger reconstructive-aesthetic body-shaping contexts as well.

Why does seroma matter clinically?

Seroma is not important only because it is common. It matters because it can delay healing, prolong recovery, require aspirations or further management, and negatively affect patient experience and satisfaction. The prevention-focused meta-analyses are built around this assumption: seroma is treated as a key postoperative endpoint precisely because it remains one of the most meaningful complications after abdominoplasty.

Risk factors: What the meta-analytic literature supports

The risk-factor evidence is less direct than the prevention literature, but several recurring themes still emerge. The postbariatric body-contouring meta-analysis supports the practical importance of patient complexity, including factors such as higher baseline body burden and more extensive contouring procedures. Even when not every paper isolates seroma-specific predictors with the same detail, the pooled complication pattern suggests that broader operative extent and higher-risk body-contouring contexts increase the likelihood of postoperative fluid-related problems.

The abdominoplasty meta-analyses point to a second major domain of risk: technique-related dead space and tissue shear. This conclusion is supported indirectly but strongly by the prevention data. The strategies that consistently reduce seroma are those designed to reduce flap mobility, close dead space, and stabilize the surgical plane more effectively. In other words, even where pooled risk-factor models are limited, the prevention literature makes clear that operative technique is central to seroma risk.

Progressive tension sutures: The clearest prevention signal

Across the current PubMed meta-analyses, progressive tension sutures (PTS) emerge as one of the most consistently supported prevention strategies. The 2024 meta-analysis by Rao concluded that PTS were more effective than drains in reducing both seroma and reoperation rates, with no meaningful difference in hematoma or infection. This is one of the clearest pooled findings in the literature.

That direction is consistent with earlier pooled evidence. The 2021 meta-analysis by Li found that abdominoplasty using PTS without drains, particularly when combined with liposuction, was effective in reducing seroma rates. Although this article is slightly older than the other prevention reviews, it remains highly relevant because it anticipated the same core conclusion that later meta-analyses reinforced: seroma prevention is stronger when the operation controls dead space structurally rather than relying mainly on passive drainage.

Scarpa fascia preservation and other dead-space strategies

The 2024 meta-analysis by Liao found that, compared with two drains alone, several alternative strategies were more effective in reducing seroma after abdominoplasty, particularly:

• Progressive-tension or quilting sutures, which help reduce dead space and tissue shear;
• Tissue adhesives, used to improve flap adherence and limit fluid accumulation;
• Scarpa fascia preservation, which emerged as one of the most promising structural strategies.

The most recent paper in the evidence set, the 2025 review by Camargo, gave even more weight to Scarpa fascia preservation. Its quantitative synthesis reported a 69% reduction in seroma occurrence when this technique was used. Taken together, these findings support a broader conclusion: the most effective prevention strategies are those that preserve structural integrity and reduce postoperative fluid space.

Drains alone are not the strongest answer

One of the most important practical conclusions from the recent literature is that drains alone are not the most convincing seroma-prevention strategy. Both the Rao and Liao meta-analyses move the field away from a drain-centered model and toward a more structural prevention model based on suturing and dead-space control. This does not mean drains have no role, but it does mean that the best current pooled evidence favors operative design over drain dependence.

Key predictors of seroma burden identified across the evidence

Across the selected PubMed meta-analyses, the most consistent themes are:

• High seroma burden after abdominoplasty, where pooled prevalence is clearly clinically relevant.
• Seroma as a dominant complication in body contouring, especially postbariatric surgery.
• Technique-related dead space and flap instability as practical drivers of risk, inferred from the superiority of structural prevention strategies.
• Better prevention with PTS and Scarpa fascia preservation than with drains alone.

Clinical implications: What the evidence means for practice

The current PubMed meta-analytic literature supports several practical conclusions:

• Seroma should be treated as a core complication target in cosmetic abdominal surgery, not as a secondary issue.
• Prevention should focus primarily on surgical technique, especially methods that reduce dead space and tissue shear.
• In higher-burden populations, such as postbariatric body-contouring patients, seroma should be understood as part of a broader postoperative complication profile rather than as an isolated event.
• The strongest pooled support favors operative optimization, particularly progressive tension sutures, Scarpa fascia preservation, and related stabilization strategies.
• A drain-only approach appears less strongly supported than techniques designed to improve structural stability.

Bibliography: Recent PubMed-indexed meta-analyses considered

Camargo CP. Therapeutical Strategies to Prevent Abdominoplasty Complications: A Systematic Review With Meta-Analysis. Aesthetic Plast Surg. 2025. PMID: 39681686.

Rao G. A Systematic Review and Meta-Analysis Evaluating the Surgical Outcomes of Progressive Tension Suturing Compared to Drains in Abdominoplasty Surgery. Aesthet Surg J. 2024. PMID: 39078654.

Liao CD. Decreasing Seroma Incidence Following Abdominoplasty: A Systematic Review and Meta-Analysis of High-Quality Evidence. Aesthet Surg J Open Forum. 2024. PMID: 38585023.

Salari N. The Global Prevalence of Seroma After Abdominoplasty: A Systematic Review and Meta-Analysis. Aesthetic Plast Surg. 2021. PMID: 34080041.

Marouf A, Mortada H. Complications of Body Contouring Surgery in Postbariatric Patients: A Systematic Review and Meta-Analysis. Aesthetic Plast Surg. 2021. PMID: 34018015.