Hardness and swelling 3 years after tummy tuck - what can be causing this?

Dear Ninamaci123,

I understand your concerns and discomfort related to your post-operative experience. A full tummy tuck with muscle repair is a significant procedure and while your healing period has been longer than typical, it's crucial to investigate any unanticipated changes.

Persistent hardness and abdominal distention years after a tummy tuck are not typical and could suggest several things. One possibility could be seroma, which is a pocket of clear serous fluid that can develop after surgery. While these usually appear sooner after the procedure, they can become encapsulated and persist.

Another potential cause could be scar tissue formation or fibrosis, which can occur after any surgical procedure. This may feel like a firm or hard area under the skin and could potentially cause the abdominal distention you've mentioned.

The worsening of symptoms with standing might suggest a component of muscle laxity or hernia, especially if the distention reduces when you lie down.

While gastrointestinal causes appear to have been ruled out by your gastroenterologist, these symptoms could still be related to underlying musculoskeletal or surgical causes.

Given your symptoms, I strongly recommend a follow-up with your plastic surgeon or, if necessary, a second opinion from another board-certified plastic surgeon who has expertise in body contouring and reconstructive surgery. An in-person physical examination, and potentially imaging studies, will provide the best avenue to pinpoint the cause and determine the appropriate treatment.

I wish you the best in resolving this issue. Remember, you should never feel you need to endure discomfort or distress, and seeking further medical advice is the right step.

Sincerely,

Dr. Katzen

Dear Ninamaci123,
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

It's really difficult to determine the cause of your concern without more information and an exam. Has it recently started or was it present since surgery? Are you overweight? It could be visceral/internal fat causing the discomfort. I encourage you to visit with your surgeon for an exam and to discuss your concerns.

You need to be checked for food allergies. The blood and saliva testing are most accurate. Many GI physicians fail to test patients for food allergies. Please discuss this with your family doctor.

I do between 150 and 200 abdominoplasties each year, and have been in practice over 25 years. That being said, I have seen thousands of patients after surgery. Without photos or physical exam, it is tough to say, but it sounds like a muscle tone issue with your abdominal wall.
While the muscle is closed with sutures, if you have had large weight changes with pregnancies or diet, the tone of the muscles might not be enough to hold things flat. Exercise, EMS machines might be helpful. Return to your surgeon or seek another opinion if that is not possible .

The most common reasons patients have bulging after a full tummy tuck, is excess visceral or intra-abdominal fat. To make an assessment on the outcome of the plastic surgery procedure we always need to see before and after pictures. Excess visceral fat can easily be determined preoperatively during a consultation, and this will have negative consequences on the potential aesthetic and physiological outcome of the procedure.
Excess visceral fat causes increased intra-abdominal pressure due to muscle tightening restricting. Is it in trouble domino space. This puts pressure against the muscle wall and diaphragm. Weight loss is the only solution. Ideally this should have been assessed preoperatively during your consultation.
Without seeing pictures, we can only make a guess. My assessment is only an assumption based on what you describe, which is the most common explanation.
Best,
Mats Hagstrom MD