Experiencing major upper abdomen swelling - what can I do? (photos)

Question

It’s been 6 months since my mommy makeover. Full tummy tuck, muscle repair, breast lift and implants. I am experiencing major upper abdomen swelling. It is protruding over my lower abdomen. I wore a Faja for 12 plus hours for 3.5 months and started to wear it occasionally again. I workout often and drink a lot of water. I do notice it gets really out of control if I have alcohol. I have cut that and my diet is under control but my swelling looks so bad. What else can I do?

Daniel Barrett, MD · Answer

Dear nellie84,
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

Alan Gonzalez, MD, FACS · Answer

Hello @nellie84, thank you for your question. It is important to take into account several aspects among which is the surgical technique applied, and to evaluate if there is something else at a systemic level. It would be wise to take an ultrasound to know what is happening. The best course of action is to consult one or several board certified plastic surgeon for more information and options tailored specifically to your needs. Best wishes! Alan Gonzalez MD. American Society of Plastic Surgery Member (ASPS), International Federation for Adipose Therapeutics and Science” Member (IFATS), Colombian Society of Plastic Surgery member (SCCP).

J. Timothy Katzen, MD, FACS · Answer

Thank you for your question regarding a distended upper abdomen with major upper abdominal swelling six months after a tummy tuck. It is not uncommon to experience upper abdominal swelling after a tummy tuck procedure, which can be caused by a number of factors.

During the surgery, excess skin and fat are removed from the lower abdomen, and the abdominal muscles are tightened to achieve a smoother, flatter appearance. However, this tightening can lead to fluid buildup in the upper abdomen, resulting in swelling and discomfort.

The use of a compression garment after the surgery can also contribute to upper abdominal swelling. While it is necessary to wear a compression garment to provide support and reduce swelling, it can sometimes cause fluid to shift upwards, leading to swelling in the upper abdomen.

To address upper abdominal swelling after a tummy tuck, it is important to follow the postoperative instructions provided by your surgeon, which may include wearing a compression garment, taking prescribed medications, and avoiding strenuous activities and heavy lifting.

While most cases of upper abdominal swelling will resolve on their own within a few weeks to months after the surgery, if the swelling persists or is accompanied by other symptoms such as pain or fever, it is important to contact your surgeon to rule out any potential complications.

Given that your tummy tuck was performed six months ago, it is unlikely that you have a seroma. However, other factors such as muscle weakness or loosening of the rectus sutures may be contributing to the distended upper abdomen. I would recommend an ultrasound or CT scan to rule out fluid collection or other underlying issues.

If a fluid collection is present, drainage may be necessary. If the issue is due to muscle weakness, muscle plication with more permanent sutures may be required. In cases where weak fascia is preventing the achievement of a flatter abdominal profile, the placement of mesh may be considered.

I hope this information has been helpful. Please do not hesitate to contact your surgeon if you have any further concerns or questions. Wishing you the best of luck with your recovery.

Sincerely,
Dr. Katzen

Camille Cash, MD · Answer

An examination is needed to determine the nature of the upper abdomen contour.  It could be related to dietary reactions, as you mentioned.  It could also be muscle repair that has failed, or internal fat.  Your surgeon should be able to provide more information after an evaluation.

Connie Hiers, MD, FACS · Answer

You need an examination to see if it is excess fat or internal swelling. If it changes with diet, you have food allergy issues and need to be worked up for that.

Darryl J. Blinski, MD · Answer

Only 1 posted side view photo? Need front views. Plus obtain upper abdomen scan or ultrasound to see if muscle repair split? If muscle repair failed only full re opening tt incision with dissection to area and re suture in 3 layers can solve this issue. Fee $5,000+++. Best to virtual with.....

Douglas Taranow, DO, FACOS · Answer

Dear Nellie,
First, more photos including a frontal photo and pics when the swelling is worst would aid in accurate answers.
I doubt that the upper abdomen is experiencing 'swelling' 3.5 months post-op.  The most common issue is either your anatomy (especially if the lower medial ribs curve outward) or the upper abdomen was not tightened adequately, or at all (
I cannot comment on that without seeing you or without re-operating (very aggressive approach which I don't suggest).
Best wishes,
Dr. Taranow

Mats Hagstrom, MD (license on probation) · Answer

There are a couple of reasons why some people have bulging on their upper abdomen after this procedure. The most common reason is individuals who have excess visceral or intra-abdominal fat. individuals who have excess visceral fat will have a bulging abdomen, and this should be established during a consultation because it leaves predictably limited results unless the patient loses weight before the procedure.
To make an accurate assessment on the outcome of a procedure we always need to see proper before and after pictures. If you don’t have before, and after pictures and ask your surgeon to forward, the ones they took. Excess visceral fat causes diffuse abdominal bulging with a tight feeling, and generally requires a lot of pressure to push your abdomen in. The abdomen does not improve from laying on your back if visceral fat is the main culprit.
The second most common reason has to do with the shape of the rib cage. Barrel chested individuals who have a sternum that sits significantly in front of the pubic bone will have an inward sloping abdominal wall after muscle tightening. This is also predictable based on the consultation before surgery. Based on your single picture, it looks like your sternum sits quite a bit in front of your pubic bone, and this causes the abdominal wall to create a beeline between those two anatomic structures from aggressive muscle tightening. Individuals who have a more round or barrel chested rib cage should be told that their upper abdomen may have a bulging appearance compared to their lower abdomen after the procedure. Surgeons can potentially back off and muscle tightening up the lower abdomen to compensate to some degree. Lower abdomen response effectively to muscle tightening, and this can create a slightly unnatural appearance on individuals who are barrel chested.
The third reason someone may have bulging on their upper abdomen, is insufficient undermining during the procedure. Undermining is the process of separating tissue layers during surgery. Typically the skin and the fat layer is separated from the muscle fascia up to with the rib cage during a full tummy tuck. For some individuals who have skin redundancy of their upper abdomen or lower part of the rib cage just below the breasts may require more aggressive, undermining all the way onto the rib cage to the point of the inframammary fold or just below the breasts. again, this is predictable based on seeing preoperative photographs, or should be deciphered during an examination during in person consultations.
A full tummy tuck is a fairly permanent and irreversible operation. Results are typically fairly predictable based on each individual person’s candidacy for the procedure. Which sufficient scale and experience plastic surgeons should be able to differentiate variations in outcomes, and ideally explain this to patience, including showing previous cases, when reviewing before, and after pictures to clearly indicates, and explain what results are likely to look like. 
The ability to accurately predict outcomes and deliver, consistent results, requires skill and experience. The ability to do this accurately and predictable will vary from surgeon to surgeon. Patients should realize there is significant difference in level of skill and experience among different providers. This also includes the ability to effectively communicate and understand, anatomic variances that can influence results 
My best guess is your outcome is related to your anatomic structures, and this result is fairly predictable based on that. Not mentioning this during consultation is probably more typical than not. The above statements represent my opinion, and other plastic surgeons will differ in their assessment, opinion, style, experience, and approach.
My best guess is revision surgery is not indicated, and that these results are going to be difficult to change.
Best,
Mats Hagstrom, MD

Joshua Jacobson, MD - Account Suspended · Answer

Hi. Many surgeons don't aggressively liposuction the upper abdomen when they do tummy tuck. I believe that may have been your case. I believe your best option is to get liposuction of upper abdomen.

Experiencing major upper abdomen swelling - what can I do? (photos)

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