Upper Abdomen Much Bigger Post-Op- Why?

This could be caused by excess fat or fluid accumulation (particularly since you mentioned that this happened very suddenly.) Your condition needs to be assessed by your surgeon, which seems like something you’ve already done. You may want to seek a second opinion if you don’t “believe him”.

There are many potential reasons for the concerns you have. It can be related to visceral fat, as your surgeon suggested. If you are early in your recovery it certainly can be from swelling, which can occur unevenly in the earlier phases of healing. It could also be a potential seroma. An examination is needed to provide further information.

Bulges in the upper abdomen following a tummy tuck often are the result of an incomplete approximation of the muscles above the belly button. We check for this in the office by having you lie flat while lifting your feet and head off of the table. This puts those abdominal muscle to work and allows for direct examination of the space between them. Your surgeon is correct that if you have too much intra-abdominal fat, no liposuction is going to correct that. However, you sound as though you no longer trust your surgeon's opinion. In that case, I would recommend seeking a second opinion.

The most common cause of an upper abdominal bulge after tummy tuck is an incomplete repair of the muscle in the upper abdomen. If your doctor is not connecting with your concerns and questions, you may need another opinion to help sort things out.
Best of luck, peterejohnsonmd

Thank you for the question.

You may be able to assess the integrity of the abdominal wall muscle plication by  flexing at the waist (diving  position)  while palpating he upper abdominal wall area. If there is significant laxity/bulging in this area when you press inwards you may be dealing with abdominal wall laxity as opposed to superficial adipose tissue.

It is somewhat unfortunate that you “don't believe” your plastic surgeon;  if this remains the case a second opinion by a well experienced/ethical  board certified plastic surgeon may be indicated.

I hope this helps.

There are several possible reasons and it usually comes down to the anatomy.

First, it can be difficult to achieve a totally flat upper abdomen.  In many patients, there is inherent fullness in that portion of the abdomen due precisely to what has been suggested - excess intra-abdominal fat.  This cannot be corrected during a tummy tuck and when this is the case the most important aspect to be discussed ahead of time is which expectations are realistic - if that area cannot be made as flat as the lower part, or as you'd like, then that's something you need to know before you proceed with the surgery.  You may still want to, or you may not.

Secondly, it could be due to ruptured sutures of the muscle repair, or incomplete repair.  My feeling, in general, is that there is not as much that can be done with sutures in the upper abdomen as many patients wish there could be; you just can't pull the whole upper abdomen tight enough - and maintain it - with some stitches.  If there is a hernia or another aspect of the anatomy that can be repaired, that may change things.  At least a bit.

Finally, you have be sure there isn't fluid there (a seroma).  It sounds unlikely, but it's possible.  My guess is that it's related to your pre-op anatomy and, assuming your surgeon did "the usual" procedure, it's been corrected as much as it can be.

But, to investigate further, you may want to consider a few more surgical opinions.  Try to obtain and take along your pre-op photos so that the surgeon can have some perspective, as well as the operative report, so that what was done will be clear. 

I hope that this helps, and good luck,

Dr. E