Multiple reasons for swollen pubic area after tummy tuck

The mons pubis appearing enlarged after a tummy tuck can be due to a variety of reasons. Swelling at the mons may take longer than the rest of the abdomen to resolve as this is the most dependent (bottom-most) part of the surgical field. Gravity pulls fluid downwards. If it does not resolve with time (3-4 months), then one must consider excess persistent excess fat. 

Prior to the tummy tuck procedure, one may not have noticed the amount of fat present at the mons pubis, as the amount of fat and skin just above the mons may have obscured this or it blended in well with the excess fat and skin present above the mons.

As the excess skin and fat is removed, the thinner upper abdominal skin (from above the umbilicus) is brought down, there may be a step-off deformity at the new abdominal skin-mons junction. This is usually addressed during the tummy tuck surgery by either by removing the excess fat present at the mons pubis by either direct excision or liposuction.

If the problem persists beyond 3-4 months, you may want to consider reduction of the the mons pubis by liposuction. If there is excess skin at the mons pubis then reduction by direct excision is recommended.

With a conventional tummy tuck, considerable skin and fat is removed.  The upper and lower skin areas (flaps) are then pulled together.  This causes tightening in the upper flap, a desired effect, but can also elevate the mons area.  The more radical the tummy tuck, the greater this effect may be.  Most patients consider some mons elevation a plus, since the mons tends to "sag" after pregnancies.

Shortly after surgery, there is swelling and firmness due to healing and swelling from the liposuction that is often performed at the same time as the tummy tuck.  Of course patients should make sure with their doctors that this swelling does not represent a collection of fluid, but that is easy to determine at your doctor's office during a postoperative check.

Patients are often under the impression that making an extra low incision will leave the final incision lower, and therefore more concealed by a bikini-type garment.

This can be false.

The lower the incision, the more skin and fat must be removed, since the upper incision is above the belly button.  In many patients, especially patients with high belly buttons or thinner patients who have less excess skin and fat to be removed, this can cause excessive tightness. 

Excessive tightness leads to poor scarring and weird elevation and elongation of the pubic structures, an uncorrectable and disturbing problem.  Excessive tension on the incision also predisposes to poor wound healing and greatly increases the chance of the skin pulling apart, necessitating weeks or months of dressing changes.

So every patient is different.  A skilled plastic surgeon can draw where the anticipated incisions will be during surgery, and estimate where your final incision will be.

It is not realistic for every patient to have a "bikini incision" after a full tummy tuck.

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Careful planning of the location of the Abdominoplasty incision is critical to the final location of the scar.  Several factors may influence the choice made by the surgeon, such as the presence or absence of a previous lower pelvic scar from C-Section, or the amount of central and upper abdominal laxity.  Although some tightening and lifting of the mons is desirable, excessive lifting of the mons, or a mons that is too thick relative to the new abdominal skin and fat now located above it, is undesirable.  As a general rule, the lower the incision can be placed, the more well-hidden the final scar will be beneath undergarments, low-rise jeans, or bikini-bottoms.

A mons that is too thick may benefit from liposuction to bring down the contour.  If the pubic hair (and the abdominoplasty scar) is too high, laser hair removal is an option to lower the pubic hairline.  Some patients also consider tattooing of the incision if it cannot otherwise be camouflaged because of an unfavorably high location.

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The pubic mound undergoes specific changes with age, pregnancy, and weight gain.  This causes the pubic mound to protrude or sag.  In some cases, the amount of pubic redundancy is not noticed by a patient in comparison to the abdominal bulge or excessive overhanging skin.

When considering an abdominoplasty procedure, the specific procedures to address the pubic mound should be discussed.  This will allow the surgeon to address this critical area during the abdominoplasty procedure.  It should be noted that the main components of an abdominoplasty do not address the pubic mound specifically. 

Thus, if you are concerned about this area, make sure to discuss treatment options including fat resection, alteration of incisional pattern, and liposuction prior to surgery.

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This is a not an uncommon problem and the reason for its occurence is that the incision line was not initially drawn low enough to take into account for its superior migration by the pulling of the upper abdominal tight skin. Fortunately, this can be often be corrected or imporved upon by scar revision.