2nd Tummy Tuck Needed for Failed Muscle Repair - Best Method?

I had a full tummy tuck 3 weeks ago. I have never seen a completely flat abdomen. I took pictures at 2 days post op and there was a slight bulge above my belly button. At my 2 week post op PS thought that I might have a failure of the muscle repair but to wait until my 6 week appt to re-evaluate. My question is what is the best way to correct the bulge? A second full tummy tuck? Endoscopically? After a FTT how far should my belly extend when I am pushing outward?

Doctor Answers (11)

What to do about Persistent above Belly Button Bulge after Tummy Tuck?

+2

Regarding: "2nd Tummy Tuck Needed for Failed Muscle Repair - Best Method?  I had a full tummy tuck 3 weeks ago. I have never seen a completely flat abdomen. I took pictures at 2 days post op and there was a slight bulge above my belly button. At my 2 week post op PS thought that I might have a failure of the muscle repair but to wait until my 6 week appt to re-evaluate. My question is what is the best way to correct the bulge? A second full tummy tuck? Endoscopically? After a FTT how far should my belly extend when I am pushing outward?"

A persistent above the belly button bulge can be caused by multiple causes. To get a successful resolution, the cause of your bulge must be diagnosed before any treatments are tried. I would suggest you wait 8-10 weeks for much of the inflammation to go away and then have your surgeon examine you. If in doubt a CT scan may be obtained. A disrupted muscle repair correction would depend on how the muscle was repaired originally (single stitches or a running stitch) and how much of the muscle length sepatated. Residual fluid can be aspirated with a needle. Residual fat can be liposuctioned.

A wait and keeping in touch with your surgeon is the best way to proceed at this point.

Good Luck

Dr. Peter Aldea


Memphis Plastic Surgeon
5.0 out of 5 stars 59 reviews

Residual bulge after tummy tuck

+1

As you have heard, a bulge can be from several different things in the early post-op time period.  It could represent swelling, a fluid collection (seroma, etc.), residual subcutaneous fat, fascial relaxation with intact sutures, or suture breakage / pull through.

The most important thing you need is a correct diagnosis, which is not something I can tell from your photos.  You may benefit from a CT scan to check things out, if physical diagnosis is not clear.  The correct diagnosis leads to the treatment plan - residual fat would be treated with liposuction, fluid collection would be treated with aspiration or a drain, and suture breakage would be treated with re-do plication.

If it turns out to be the sutures, I would wait until after the inflammatory post-surgical changes settle down prior to going back in.  (Inflammed tissues don't hold sutures well.).  I would repair it through an open approach, opening the middle third of your incision.

 

All the best,

Thomas Fiala, MD
Orlando Plastic Surgeon
5.0 out of 5 stars 25 reviews

Upper abdominal fullness after abdominoplasty

+1

First off you should not attempt to push outwards. It is in your best interests to perform core strengthening. In regards to your upper abdomen, it could be due to several causes, In many instances, it is fat which can be removed at a later operation and should probably NOT be removed at the initial operation due to concerns with the blood supply to the lower abdominal skin. Diagnostic imaging may help determine the cause of the fullness.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
5.0 out of 5 stars 43 reviews

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Bulge after a tummy tuck

+1

The cause of this must be determined first.  It can be simply swelling in the tissue, or residual fat above the umbilicus, or fluid trapped under the skin (seroma), or maybe a muscle repair problem.  An ultrasound can help determine which of these is the culprit.  Probably a muscle repair problem would be the least common as long as you went to a very experienced plastic surgeon. 

Richard P. Rand, MD, FACS
Seattle Plastic Surgeon
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Bulge after a tummy tuck

+1

The key thing is to figure out what the cause of the bulge is?  Is it swelling, is it a fluid collection, is it a hematoma, is it a weakness in the muscles.  An exam may help determine this and then you can go from there.

Steven Wallach, MD
Manhattan Plastic Surgeon
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It pays to wait before revising an abdominopalsty

+1

Three weeks (even 6) is too soon to consider secondary surgery after an abdominoplasty.  It takes time for the swelling to go down and chances are you may not need a second surgery. I would not consider it for at least 3-4 months.  If the problem persists, there are several choices and I would explore them all with your surgeon.  Consider:

  • a muscle tightening suture that broke
  • not enough tightening (sometimes a horizontal tightening adds to the vertical one)
  • fluid collection (seroma, usually in the lower abdomen)
  • excess fat (assuming liposuction was not done )
  • the belly button was reset too low 

Don't be in a rush.  An abdominoplasty is a big procedure.  Give the healing process time.

Lori H. Saltz, MD
San Diego Plastic Surgeon
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Post tummy tuck bulge

+1

The best advise is to follow up with your surgeon to express your concerns. There is no best way,only choices. Perhaps it may improve with time to some degree to make any revision less aggressive. Hope for the best but don't lose hope. Your surgeon knows all of the options for you to consider.

Timothy Fee, MD
Jacksonville Plastic Surgeon
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Wait a bit before revision surgery

+1

I have to agree that waiting a bit will be helpful. I have had several appear as you do, and most look much better as time goes on. This upper area has usually undergone some liposuction so it may have more swelling, and it can also trap excess fluid. With time alone it might go down. If it is due to fluid I have sometimes had to drain it out with a needle. Suture failure is usually not the issue, since the sutures are very strong. If your fascia (the gristle on top of the muscle where the sutures are) is very weak, the sutures can cut through like a wire through cheese, and cause the bulge you see. One final cause of the upper bulge can be that the sutures in the upper abdomen are not tight enough. The reason this can happen is when you are flat on your back in the operating room, your upper back is either straight or arched much more than when you are standing up in your normal posture. When you are standing your upper back is curved.  The tummy seems tight to the surgeon when the sutures are placed, but are actually as tight as they need to be when you are standing. One thing which has helped me prevent such bulges is to place one layer of sutures in the upper abdomen, then to do the lower abdomen sutures (2 layers) then to go back to the upper abdomen for the final layer up there. It is always bulging more after the lower sutures are placed.

Victor Au, MD
Chapel Hill Plastic Surgeon
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Tummy tuck

+1

Perhaps. some of the sutures, holding your muscles together, broke.  I agree with your plastic surgeon.  if things don't improve in the next several weeks, one could enter the umbilicus incision, and repair the problem, if it exists.  Good luck.

Shahin Javaheri, MD
San Francisco Plastic Surgeon
3.5 out of 5 stars 2 reviews

Abdominal Swelling Following Tummy Tuck

+1

It’s not unusual for patients to have swelling in the immediate post-operative period following abdominoplasty.  This swelling usually takes about 6 to 8 weeks to resolve, but in some cases may persist for up to 3 to 4 months.  For this reason, discussion of revisional surgery is premature at this point in time.

Persistent abdominal bulges can occur for a variety of reasons.  These include residual muscle weakness, excess skin, intra abdominal fat, excess subcutaneous fat and seroma formation.  The treatment of these problems is specific and based on the cause of the condition.

At this point in time, it’s important to be patient.  If the bulge persists an appropriate evaluation should be under taken and appropriate treatment instituted.

Richard J. Bruneteau, MD
Omaha Plastic Surgeon
5.0 out of 5 stars 74 reviews

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.