Protruding abdomen 8 months post abdominoplasty - advice? (photos)

Question

Since I had little drainage, drains were removed 1 week po, which seemed usually painful. I then had terrible swelling from seroma in my pubis area--over 100cc of seroma was drained every three days for about 2 weeks. My pubis became flat but my hairline was very high and it was apparent that not enough skin had been taken above my scarline. A revision was performed to removed some scar tissue and an addition skin. Left w/ terrible bulging and discomfort over the scarline up to my belly button.

J. Timothy Katzen, MD, FACS · Answer

Thank you for your question regarding your abdomen after your tummy tuck or abdominoplasty, development of a postoperative seroma, and then subsequent surgical revision. Based on your history and your picture, there is only one thing to do, namely surgical revision. Since you specifically state that the hairline and scar is too high, skin needs to be removed. The only way to remove skin is with surgery. I would wait til you are a complete one-year post-op and then undergo a revision. This will allow complete resolution of swelling and scar tissue. During your revision, I would definitely use drains and keep the drains in for an extended period of time. The surgical revision will require removal of further excess abdominal skin and lowering of the tummy tuck scar. Thank you for your question regarding what to do with your abdomen after a tummy tuck and postoperative seroma.

Sincerely, Dr. Katzen.
(“Verified” Plastic Surgeon, President of the American Society of Bariatric Plastic Surgeons, certified by the American Board of Plastic Surgery, Fellow of the International Society of Aesthetic Plastic Surgery, American College of Surgery, International College of Surgery, and American Board of Metabolic and Bariatric Surgery, and member of the American Society of Plastic Surgery, American Academy of Cosmetic Surgery and RealSelf Hall of Fame.)

Sincerely, Dr. Katzen. 
(“Verified” Plastic Surgeon, President of the American Society of Bariatric Plastic Surgeons, certified by the American Board of Plastic Surgery, Fellow of the International Society of Aesthetic Plastic Surgery, American College of Surgery, International College of Surgery, and American Board of Metabolic and Bariatric Surgery, and ​member of the American Society of Plastic Surgery, American Academy of Cosmetic Surgery and RealSelf Hall of Fame.)

Daniel Barrett, MD · Answer

Dear Helpful5770,
I understand your concern. However, without a proper assessment, it would be difficult to determine what went wrong. It is best that you visit your plastic surgeon for further assessment or ask for a second opinion. Only after a thorough examination, you can get proper recommendations and advice.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Stefan Mark Szczerba, MD · Answer

Hmmm... tough one. I would've reinserted a drain(s) and have you start on compression. These issues are tough but I usually follow the outputs and remove typically 1st drain on day 7 and 2nd drain anywhere on day 8-11 depending on the output. I like JP's after TT and lipo to put out 10-15cc/24 hours. I cannot tell if you had a full TT or a miniTT. If you had a miniTT, the lower part does stay swollen hence the need for compression. Best Wishes!!

Nelson Castillo, MD · Answer

Thank you for sharing your question and photograph. Difficult to comment without an in-person examination but it does appear that an irregularity in the sewing of the tissues, or the thicknesses were not accounted for at the time of surgery.  Most likely a surgical revision to  correct will be required and depending on extent of skin laxity a full tummy tuck may be needed versus a scar revision alone.  Seek out secondary in-person consultations for best advice.

Camille Cash, MD · Answer

I'm sorry to hear of the photos you are having since your tummy tuck.  It is possible that another seroma has developed which can be diagnosed with an ultrasound.  Was compression used after the second surgery?  I encourage you to discuss your concerns with your surgeon.

Connie Hiers, MD, FACS · Answer

It is possible that you have another seroma, even an organized one. Your surgeon can order an ultrasound to see what is causing the bulging.

Mats Hagstrom, MD (license on probation) · Answer

Your situation is fairly complex.

I suggest scheduling second opinion in person consultations with local board-certified plastic surgeons to get an appropriate assessment and better understanding of your results and what can be done to improve your outcome.

Best,

Mats Hagstrom MD

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