Was this tummy tuck repair a failure? (Photo)

Question

I had a second tummy tuck because I woke up one day very bloated and uncomfortable. When my surgeon went back in he said this wasn’t really repair failure and everything was still in tact. This picture is before he resutured me again with two sutures. I’m still bloated looking. I’m wondering if this was repair failure because now they suspect maybe that bloat feeling all the time is endometriosis bloat and I need a hysterectomy. Please let me know your thoughts if this looked like failure. Thanks

Daniel Barrett, MD · Answer

Dear Ana090909,
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, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Camille Cash, MD · Answer

Bloating can be caused from many underlying causes.  Even if your muscle repair failed it could impact the abdominal contour, but likely wouldn't make you feel bloated and uncomfortable.  I encourage you to continue to explore your symptoms with your OB/gyn and possibly a GI specialist.

Mats Hagstrom, MD (license on probation) · Answer

To make an assessment on the outcome of a plastic surgery procedure we need to see proper before and after pictures. And then try operative picture showing your abdominal wall isn’t really particularly helpful.
The number one reason for patients having a bulging abdomen after tummy tuck is excess visceral fat related to being obese. Excess visceral fat should not be that difficult to assess and can generally be noted on preoperative pictures.
Failure of muscle tightening is unusual reason for bulging after a tummy tuck. The most common reason is access to visceral, fat and weight loss usually improves the situation better than anything else. Some people also have body contours that are prone to having bulging especially of the upper abdomen. Individuals who are barrel chested with a sternum that sits significantly forward in relationship to the pubic bone may see a backwards sloping, abdominal wall that has more relative bulging in the upper abdomen compared to the lower abdomen. Body contour, especially the relationship of the sternum to the pubic bone and individuals with excess visceral fat are by far the two most common reasons patients get bulging after a tummy tuck.
Consider re-posting with proper before and after pictures to get an assessment on the outcome of your procedure. Alternatively, consider scheduling second opinion in person consultations with other board-certified plastic surgeons. To get an assessment on the outcome of your procedure you should always present proper before and after pictures and for a second opinion in person consultations consider bringing a copy of your operative report. Since you’ve had two operations, you should ideally have copies of before and after pictures and the operative reports of operations. 
There are four tissue variables that determine what the abdomen looks like. If somebody doesn’t like her abdomen, whether they’ve had a tummy tuck or not, the problem is always going to be one or more of those four tissue variables. The four tissue variables that determine what the abdomen looks like abdominal skin laxity typically due to previous pregnancies or weight loss, excess subcutaneous fat, muscle separation from previous pregnancy or excess visceral or intra-abdominal fat.
A tummy tuck primarily treats of Domino skin, laxity and muscle separation. If patients are still bulging, then there are only two variables left. Subcutaneous fat is fairly self explanatory and is usually improved by pulling the skin and fat layer tight during the procedure.
This week’s axis, visceral fat is the most likely culprit, and this is sometimes overseen by both patients and providers when making assessments before having the operation.
To assess or identify if visceral fat is creating a problem, you can try a few different things. One is to lay on your back and see if your abdomen improves in that position. Patients who have a bulging abdomen due to muscle separation will generally get a significant improvement when laying on their back. If the abdomen still bulges while you’re laying on your back, then visceral fat is most likely a significant component.
The other way to determine if the visceral fat is a significant issue is to the press the abdomen flat until the abdominal wall is perfectly lined up with the sternum and pubic bone. If this takes a significant amount of pressure to do then, visceral, fat is most likely contributing significantly and weight loss is indicated to get a better outcome. Muscle tightening reduces the intra-abdominal space and individuals who have excess visceral fat will get increased intra abdominal pressure, which intern presses against the abdominal wall, making it tight. 
Differentiating the different tissue variables is not rocket science and most talented plastic surgeons should be able to differentiate what is causing your abdomen to appear the way it does without too much difficulty.
Consider getting second opinions before having revision procedures if you’re not sure what’s going on.
Best,
Mats Hagstrom, MD

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