13 Weeks After Full Tummy Tuck and my Belly Looks Like Im Pregnant is This Normal? (photo)

Question

my belly looked flat on the first weeks and then the swollen just gets worse every day and i wear my garment 24/7. I am afraid that something is wrong and its really frustrating because my dream was to have a flat belly ... and since the surgery i lost 15 pounds current weight now is 135 lb and i am 5.3.

Jeffrey Rockmore, MD · Answer

Thank you for your question and for providing the photos. There are a variety of causes of fullness after a tummy tuck, and the only way to truly diagnose the problem would be with an actual exam. I would recommend seeing your plastic surgeon immediately to be assessed.

	If your belly was initially flat, one of the common causes would be fluid build up after the drains are removed, called a seroma. This is treated relatively easily and can restore the flat belly. Other possibilities include recurrent laxity of the muscles or motility issues of the intestine.

	Again, I would recommend seeing your plastic surgeon immediately.

	Best of luck with your belly.

	Jeff Rockmore

Sacha Obaid, MD · Answer

Your story is worrisome as the swelling should not be steadily increasing 13 weeks post op. I am concerned you have a fluid collection called a seroma. I recommend being examined by your surgeon to make sure things are okay.

Jaime Perez, MD · Answer

Hello. I would recommend you start exercising your abdominal muscles. After 13 weeks it is safe to start now. What may be the problem is that your muscles aren’t powerful enough to keep your viscera from protruding despite plication of the abdominal muscles.

	Jaime Perez, MD
	Tummy Tuck Specialist
	Plastic Surgery Center of Tampa

Jeffrey M. Darrow, MD · Answer

I agree that your belly should not be getting more protuberant as time passes. It is normal for patients abdomens to be slightly full for the first several weeks after surgery as swelling resolves, but then the belly should be flat. Only a face to face exam could give an accurate assessment as to why your abdomen is swollen, so re check with your plastic surgeon who knows exactly what was done during surgery and knows you best.

Pablo Prichard, MD · Answer

Thank you for your post.  Seromas can be painful and cause a cosmetic deformity, as well as sometimes leak.  The whole point of drains is to keep a seroma from happening in the first place.  If a drainless procedure was performed, and you had a seroma, or you had drains that were pulled and you subsequently had a seroma, then you should be drained, otherwise a capsule builds around the fluid making it permanent.  If a capsule builds around the seroma (pseudo bursa or encapsulated seroma) then the only way to remove the seroma is to surgically open the areas and excise the capsule, and close over drains to prevent another seroma from happening.  If the seroma is encapsulated and is tight and painful, then it can be confused with just swelling or fat.  An ultrasound is useful in distinguishing these and identifying the extent of the seroma. If the seroma is not yet encapsulated, then it is usually loose and has a 'fluid wave' or water bed type feel.  Occasionally, a seroma can also become infected, especially if a permanent braided suture was used.  This will have a hot, red appearance, and will eventually open up.  I have never seen an infection from sterile aspiration of fluid.Best wishes,Pablo Prichard, MD

Darryl J. Blinski, MD · Answer

Based upon your posted side view and history seek immediate medical assistance from your surgeon. Could be fluid collection.

Jourdan Gottlieb, MD · Answer

No, not normal. And since this apparently looked better early on, a sign of some sort of complication. Two possibilities are most likely.

	
		 Fluid collection-blood (hematoma) or serum (seroma) of which the latter seems likelier absent any marked bruising that would be expected. 
	
		Breakdown of the muscle repair.


	The first of the two would be treated by aspiration, often more than once, and sometimes accompanied by replacing the drain. 

	The second would unfortunately require a return to surgery. 

	Your next step should be a call to make an early appointment to see your surgeon.

	Thanks for sharing this story and photo, all the best.

Scott E. Kasden, MD, FACS · Answer

This is problematic.  I can think of two possibilities off hand, and both require a trip to your surgeon to evaluate.

	The first is a fluid collection, likely a seroma.  The confounding thing about this is that you have lost so much weight.  The seroma fluid has mass and will increase weight.  Hopefully, if it is a seroma, it can be treated with aspiration.

	The second, more onerous possibility is that the suture may have broken.  If the surgeon used only a "running" suture the muscle repair may have come undone.

	In either case, go in, get evaluated, get a plan, get going, and stop worrying.  Worst case, it can be fixed.  Just details from this point.

	sek

Parviz Goshtasby, MD, FACS · Answer

Hello 'Atlanta mommy', thanks for your question. It is abnormal that your abdomen was flat during the first weeks, but has become increasingly swollen since then. I am not sure when your drains came out, but one possibility is a postop seroma fluid collection, especially if the drains were taken out a bit early. This can be usually managed with office drainage and compression garments. The other possibility is if your rectus muscle plication sutures have torn, leading to recurrent laxity of your abdomen. It is unclear what is going on without a thorough examination, so I would recommend seeing your doctor right away to address this issue. Hopefully he is a board-certified plastic surgeon who should be well-trained and adept at handling these postop issues. Good luck! - Dr.92660

Lisa M. DiFrancesco, MD · Answer

Thank you for the question. After a tummy tuck the swelling should be improving not getting worse. There can be a number of reasons for this fullness and the best way to determine the cause would be an exam. I recommend you return to see the plastic surgeon who preformed the tummy tuck as soon as possible. It may be a seroma which is a fluid collection and can be treated with a drain. It may be from continued weakness or laxity of the abdominal muscles.

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