Bulge on top of my stomach 2 years after TT. Is it the sutures? (Photo)

Question

Had a lipo 360 TT& MR 2 years ago I'm 90 pounds I came out with a very small buldge on the top of my stomach when I pass my hand down I feel like a bump then a dent then it feels hard again but 2 yrs later it just getting very big and I feel like I'm going to snap I've had Ct scans ultrasounds and X-rays everything looks fine inside with my organs Is it the sutures? I doubt it's visceral fat, dr suggested going under again and just removing sutures and doing them again no Skin removal

Alan Gonzalez, MD, FACS · Answer

Hello @moniquecastelo, thank you for your question. It is critical to consult the doctor treating the surgical procedure. This is because he knows what type of technique he or she used and how he or she performed the procedure. Ask if a lower or total muscle tie was performed, and you will be able to clarify your doubt. For more information and recommendations, it is best to consult with one or several board certified plastic surgeons. Best wishes! Alan Gonzalez MD, FACS.

Jason Hess, MD · Answer

In general, it appears as though there is residual or recurrent fascial laxity following prior abdominoplasty.During traditional abdominoplasty, the skin of the abdomen is lifted up to the xiphoid process approximately.  The fascia is then repaired in the midline in 2 layers.  This means that the layer over the muscle is tightening and sutured.  It appears as though the fascia is tighter in the region below the navel than above the navel.  To my knowledge, the only way to repair this is to revise the suture plication.  This involves lifting the skin from the rectus fascia and repairing the laxity.  Good luck in your upcoming revision.

Daniel Barrett, MD · Answer

Dear moniquecastelo,
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

Connie Hiers, MD, FACS · Answer

It is possible that your muscle tightening of the upper abdomen has come loose. This is very uncommon this fat out from surgery, but it can be retightened.

Camille Cash, MD · Answer

An in person evaluation is always best but from your photos and description the likely cause of the area that concerns you is abdominal wall laxity.  In order to correct this a tummy tuck revision would be needed in order to suture the upper abdomen.  No further skin excision appears necessary.

Douglas Taranow, DO, FACOS · Answer

Your upper abdomen would require a revision procedure where the upper Rectus muscle fascia would be plicated (sutured).  I agree that you do not require any further skin excision.
Dr. Taranow

Darryl J. Blinski, MD · Answer

Thanks for posting photos. Until a PS sees the scan results and does virtual or in person examination hard to determine if split muscle/recti repair or just excess sub cutaneous fat. Or BOTH? If recti split then only re operation full TT with layered recti repair and possible adbsorbale mesh can correct. If fat then only lipo needed.

Mats Hagstrom, MD (license on probation) · Answer

It’s difficult to make an assessment from the pictures you have included. Typically we make assessments by seeing proper before and after pictures. If you don’t have your before and after pictures then ask your surgeon to forward the ones they took.
It’s important to know what you look like before surgery when assessing the outcome of a procedure.
There are three reasons someone can have a bulging upper abdomen after a tummy tuck.
At least from what I have seen.
The two most common are either patients who have excess visceral fat in this can usually be seen on the before pictures and during an examination before surgery.
The second reason is individuals who are barrel chested. Bellchasse individuals tend to have their sternum sit in a more forward position compared to their pubic bone and wonder muscle while it’s lightning during surgery it causes the lower abdomen to come in more dramatically while the upper abdomen bulges because of the shape of the rib cage.
Sometimes it’s the combination of both of these.
If you hear to get more effective muscle tightening of the lower abdomen during surgery so anything that allows the upper abdomen to bulge like having a bulging rib cage or visceral fat will do so well the lower abdomen will hold tight from the surgical tightening.
Try reposting with standard before and after pictures showing your full torso in the standing neutral position from the front and side. 
If you want a proper in person second opinion consultation come prepared by bringing a copy of the operative report and the before and after pictures.
Re-operating doesn’t make sense until the surgeon knows what the problem is.
Best,
Mats Hagstrom MD

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