Why do I have a big upper belly bulge after full TT?? (Photo)

Photos the night before my full TT. The doctor said by recti was seperated five inches. He did one layer dissolvable stitches and one permanent. After this my stitches started coming about so he did another layer of permanent sutures. Could my abdominal wall be very weak and needs mesh for extra support. My upper abdominal area looks like maybe I have a hernia??

Doctor Answers 11

Avoiding the upper abdominal bulge in a tummy tuck

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A tummy tuck isn't a magical procedure.  It only works for the right patients.  I see many patients who want a tummy tuck but I turn away anyone who isn 't a good candidate.  In order be a good candidate there has to be musculofascial laxity with some loose skin.  There cannot be significant intraabdominal fullness.  If there is fat on the inside of the body, trying to tighten the muscles simply will not help.  The fat will push back against the repair and recreate fullness.  This happensmost likely in the upper abdomen because that is where it is hardest to fully tighten the muscles.  If the patient can't "suck it in" and create a change, then there is too much intraabdominal fat and the patient needs to loose a little weight before going forward.  So based on the pictures it is possible that was the case.  Some weight loss will likely help at this point.  If the person in the photos can "suck it in" nicely at this point then they may simply have a relaxation of the muscle repair that was done initially.  Hopefully the fascia is tight and exercise with core strengthening will help.  But is suspect that the result is a technical issue in that the upper muscles were not tightened enough or the repair failed over time.  The only thing to do in that situation is reoperate and retighten the fascia.  I always try to avoid this outcome by properly selecting patients and when I do operate, I make sure I tighten all the way to just below the ribs with the same tension I do below the belly button. Best of luck.  

Cleveland Plastic Surgeon
5.0 out of 5 stars 148 reviews

There are many possible reasons for a bulging upper abdomen

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We can talk about technical details of the operation, but it's of little importance at this point. An issue that has not been raised by my colleagues is how much visceral fat you have in your abdomen. If the abdominal wall is tight due to intra-abdominal contents, tightening it further will not help. In point of fact, it will lead to increased upper abdominal bulge. As the abdominal wall heals and the tension of its contents  increases, it will bulge at it's weakest region, the epigastrium. If the lower abdomen is pulled tightly, it only increases the problem. A simple test is to lie on your back and relax your abdominal wall. If the abdomen falls down from the ribs, you have a loose wall and tightening will help. If the abdomen rises in a bulge, the contents cannot be made smaller by tightening, the wall is already tight. It is true that re-operation could help. You take down the plication in the lower abdomen and tighten the top. That might solve the problem. But it's a big deal. I hate to say it, but weight reduction might give some improvement. Clearly a diagnosis and treatment plan can not be made by a few pictures on line, you need to see your surgeon and they need to help formulate a plan. Best of luck.

Peter D. Geldner, MD
Chicago Plastic Surgeon
4.6 out of 5 stars 34 reviews

Bulge after tummy tuck

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Without a physical exam, it's very difficult to ascertain the answer you're looking for. Three possibilities exist. First would be fat that wasn't liposuctioned. This is common after  tummy tuck as we want to leave as much blood supply to that flap that we've elevated. This can be addressed with a secondary liposuction several months later. Another possibility would be that you have pulled apart the hernia repair. Your plastic surgeon can check for that at a postop visit. Third possibility would be a persistent seroma or fluid collection above the hernia repair and below the skin. A simple ultrasound could ascertain if that is the case in the fluid could be withdrawn. I recommend going back to see your plastic surgeon and discuss this with them. Good luck with your future recovery. 

Marc J. Salzman, MD, FACS
Louisville Plastic Surgeon
4.7 out of 5 stars 58 reviews

Physical evaluation will be needed

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Many possible issues can cause this issue.  Evaluation from photos will not answer your question. Go and get evaluation from your doctor. 

Vasdev Rai, MD
Dallas Plastic Surgeon
5.0 out of 5 stars 24 reviews

Big upper belly bulge after full TT.

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Without an examination it is difficult to know what has happened, though the suture does not seem to have held up in the diastasis repair. If you do have a hernia, then mesh might be the solution. An office examination will help sort out the issue.

Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 44 reviews

Upper Belly Buldge After Tummy Tuck.....?

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Yes, I agree!   If your surgeon had a difficult time getting your tissues to hold the stitches during surgery, and now you have a large buldge of your upper abdomen as seen in your photos, I would agree that you will likely need Mesh or Strattice to reinforce your rectus plication/repair.  This however involves repeating the majority of the tummy tuck procedure to place the mesh or strattice.  

Daniel P. Markmann, MD
Baltimore Plastic Surgeon

Why do I have an upper abdominal bulge after tummy tuck?

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Without knowing more technical details it is difficult to fully explain what has happened, but it is clear that your diastasis correction is much more successful in your lower abdomen than above the umbilicus. With a wide diastasis, it is important to be careful in the operating room to plicate the fascia all the way up to the breast bone, and be careful to keep the plication at even tension with a pleasing "hour glass" at the waist line. Either some sutures pulled out or resorbed, or too much attention was paid to the lower abdomen which I have seen before.  In my experience, mesh is not necessary to get a nice outcome even with a wide diastasis.  However, I think you will benefit from revisional surgery if the bulge does not correct itself.  Occasionally a seroma that fails to resorb can also cause a bulge in that area.

Buldge after tummy tuck.

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Thank you for your question. The bulge you describe could be due to few reasons such as remaining adipose tissue, uneven repair of abdominal wall with bottom portion being too tight or inadequate repair of the top portion, etc.
it's best to have a discussion with your plastic surgeon first and/or consult  another plastic surgeon in your area.

Dhaval M. Patel, MD
Hoffman Estates Plastic Surgeon
4.8 out of 5 stars 100 reviews

Upper abdominal bulge after tummy tuck

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Hi, Thank you for your photos. You pose a difficult question here since we do not know what your tummy looked like before the surgery.  While it is possible that you have a hernia and your muscles are weak, this usually occurs in the lower abdomen.  Speak to your surgeon and ask to review your photos.  The area of your concern may have been present before your surgery and may benefit from some liposuction. 
Good Luck,  Dr Bev

Beverly Friedlander, MD
Short Hills Plastic Surgeon
4.8 out of 5 stars 19 reviews

Rectus plication

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I Would discuss your concerns with you surgeon but it appears as if you are more tightly sewn up below your umbilicus than you area above.... but you probably already knew that.
My best,
Sheila Nazarian

Sheila S. Nazarian, MD
Beverly Hills Plastic Surgeon
4.8 out of 5 stars 56 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.