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Bulge in my Upper Stomach 5 Month After TT, Visceral Fat or Something Else?

I had a full TT with liposuction of the flanks. Also had a panniculectomy done. I still have a big bulge in my upper stomach. My OB thought I had a ventral hernia which is why I had these procedures all done. Turned out to be diastasis recti. My PS thought it was about 2 fingers, it ended up being 4 fingers. Had procedure done back in july of this year. I have been doing aggressive abdominal excerises and this bulge is still the same. Visceral fat or something else?

Doctor Answers (3)

Bulge in upper abdomen 5 months after tummy tuck--what is it?

+1

You can't have had a panniculectomy AND a tummy tuck done, since a properly-performed tummy tuck removes everything (and more) a panniculectomy does, PLUS tightens the muscle layer (rectus sheath plication) that a panniculectomy DOES NOT.

Panniculectomy is removal of only the overhanging skin and fat "apron" after weight loss, whereas a true tummy tuck (abdominoplasty) involves removal of more skin and fat, transposition of the umbilicus (same belly button, new skin opening), and muscle repair (rectus sheath plication).

I suspect that your surgeon performed a panniculectomy for insurance coverage, and then charged you "extra" for the cosmetic tummy tuck. I'll leave the ethics of this situation for another question and answer, but this COULD explain your confusion, and perhaps also have something to do with your concern.

If in fact your surgeon charged you for a cosmetic tummy tuck but did NOT perform a full breastbone to pubic bone muscle repair, then your upper abdominal bulge is your visceral contents bulging through an untightened (or incompletely tightened) rectus sheath. To be fair, this sometime occurs even when a full plication is properly done, and there is simply too much subcutaneous fat in the upper abdomen (or too much intra-abdominal fat). To remove the excess SubQ fat at the time of tummy tuck is possible, but not  without damaging the blood supply to the lower abdominal tissues and perhaps causing dead skin. Bummer, and a BIG problem. So the bulge remains to be addressed another day after the tummy tuck heals completely. Or after you lose more weight.

But if plication was done (and your information implies it was since 2 fingers vs 4 fingers is a measurement of severity of the muscle wall stretch), it may simply have been insufficient to deal with the pressure from your intra-abdominal contents bulging outwards. Talk with your surgeon, and understand that your own weight may have a role in your result! Best wishes!


Minneapolis Plastic Surgeon
5.0 out of 5 stars 126 reviews

Bulge in my Upper Stomach 5 Month After Tummy Tuck

+1

Not quite sure HOW you had both a Full Tummy Tuck AND a Panniculectomy since a full Tummy Tuck is basically a panniculectomy AND much more.

The best person to tell you the reason for the bulge is your Plastic surgeon. He was the last one there and should know what it is especially if the bulge has been there before and especially if it persisted after surgery. In many cases it is due fat where the separated muscles were brought together and can be resolved with liposuction.

It is most likely NOT visceral fat which would imply complete failure of the muscle repair and a large hernia.

See your surgeon and you will find out.

Peter A. Aldea, MD
Memphis Plastic Surgeon
5.0 out of 5 stars 62 reviews

“Bulge” Upper Abdomen after Tummy Tuck?

+1

Thank you for the question.

Unfortunately,  it is not possible to make a diagnosis without direct physical examination. It would be in your best interest to be examined by your plastic surgeon who will be able to ( based on examining you in different positions)  determine whether the “bulge” is related to abdominal wall laxity,  adipose tissue etc. The “visceral fat” you mention is deeper to the structures involved with your surgery ( intraperitoneal).

Best wishes.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 759 reviews

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These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.