Will my muscles and fascia stretch again if I get a tummy tuck revision?

Question

I had a Tummy Tuck and at first it looked great. Then at about month 2 my stomach started to bulge back out and now it’s back to a 50% reduction with a bulge in my lower abs. I saw my surgeon and he said my fascia stretched out because I’m just the 1% of patients that this can happen to. He thinks my stitches are fine, but my muscles and fascia are just stretch after pregnancy. He doesn’t usually do revisions, and he thinks if I get a revision it may just all stretch again. Is that true?

Emmanuel De La Cruz, MD · Answer

A tummy tuck (abdominoplasty) revision is a surgical procedure to correct or improve the results of a previous tummy tuck. Whether your muscles and fascia will stretch again after a revision depends on several factors, including:

Surgical Technique: During a tummy tuck, the surgeon typically tightens the abdominal muscles and removes excess skin and fat. If the revision surgery involves re-tightening the muscles and repairing the fascia, the chance of them stretching again might be reduced. However, how well this holds depends on the skill of the surgeon and the techniques used.

Healing and Recovery: Proper healing and following post-operative care instructions are crucial. Adequate rest, avoiding strenuous activities, and following a healthy diet can help ensure the surgical repairs remain intact.

Individual Factors: Your body’s unique characteristics, such as skin elasticity, muscle tone, and overall health, play a significant role

Roni Prucz, MD · Answer

Without photos it is difficult to specifically answer your question. However, abdominal bulges can happen after any abdominal procedure including tummy tuck. Sutures can become loose, the fascia can stretch, and the muscles can lose their tone. Fortunately, repeat plication can often be successfully performed during a tummy tuck revision. The repair can also be reinforced with mesh. I have successfully eliminated abdominal bulges from other surgeons with long lasting results. You should discuss your care with a Board Certified Plastic Surgeon who will be able to provide more information. Thank you for your question!

Zoran Potparic, MD · Answer

In many cases situation like yours arises from additional weight gain. Intrabdominal fat content  and increased abdominal pressure will stretch any facial/muscle repair.; too early vigorous excersize would do the same. It is very likely that condition may return after new facial repair even after using a  mesh. Sometimes this bulge is due to weakness and separation of multiple components of abdominal wall and repair may need a more  complex repair than muscle/fascia plication.

Connie Hiers, MD, FACS · Answer

You can stretch anything except bone. There may be a reason for your tissue to stretch again that is due to internal things. Please get checked for food allergies because food allergies can cause your colon to swell.

Camille Cash, MD · Answer

If you choose to have a revision it is possible that the abdomen could stretch again.  Sometimes the culprit for a rounded abdomen after surgery is that the repair failed, or more often it is due to visceral fat.  This is internal fat behind the muscle wall that surrounds your organs.  This fat cannot be addressed with a tummy tuck or liposuction, but will improve with weight loss.

Mats Hagstrom, MD (license on probation) · Answer

To make an accurate assessment regarding the outcome of any plastic surgery procedure we need to see a complete set of proper before and after pictures.
If you don’t have before and after pictures, then ask your surgeon to forward the pictures they took.
Failure of muscle tightening is extremely uncommon.
By far the most common reason patients bulge after a tummy tuck is because they have excess intra-abdominal or visceral fat.
This should’ve been assessed during your consultation before scheduling surgery.
Individuals who have access visceral fat are not great candidates for liposuction until they first lose weight.
Without even seeing pictures. I’m quite certain that is what your underlying problem is.
 I see this so often.
There are four tissue variables that determine what the abdomen looks like.
Each of these tissue variables has its own way of being treated.
To get a quality assessment before surgery. It is important to understand which variables are contributing.
The four tissue variables that determine what the abdomen looks like are the following.
1) abdominal skin laxity typically due to previous pregnancies or significant weight loss.
2) excess subcutaneous fat.
3) muscle separation from previous pregnancy.
4) excess visceral or intra-abdominal fat.
A tummy tuck will treat skin laxity and muscle separation.
Excess subcutaneous fat can be reduced with liposuction or weight loss.
Excess visceral fat can only be reduced with weight loss.
Doing a tummy tuck on someone who has access, visceral fat will always end up with a bulging abdomen.
The volume of excess visceral fat has to go somewhere.
 visceral, fat and muscle separation can have a fairly similar appearance during initial preoperative evaluation.
Differentiating between the two isn’t rocket science and is something all plastic surgeons should know how to do.
You can do this whether you’ve had surgery or before you have surgery.
It is, however much better to assess the presence of excess visceral fat before you have a tummy tuck so you can understand your candidacy and neither not have the procedure or lose the appropriate amount of weight before surgery to get a quality outcome.
One way to differentiate is to see what your abdomen looks like if you lay on your back.
If the problem is exclusively related to muscle separation, then the abdominal wall should have a concave appearance when you lay on your back.
The abdominal wall should fall into the abdomen, making it not only flat but concave. an individuals with access visual fat even when, laying on their back, the rabbit men may still bulge slightly.
The other way to differentiate is to determine how much pressure it takes to press your abdominal wall flat. For reference a flat abdominal wall should create a beeline between the sternum and the pubic bone.
If you envision align between the sternum and the pubic bone, try pressing your abdominal wall until it reaches that imaginary line and try to hold it in this position with your non-dominant hand for several minutes.
 If this takes a lot of pressure, then excess visceral fat is a significant problem and most likely the reason your results are not to your liking.
To get a flat abdomen, you need to lose weight.
To understand how much weight you need to lose a suggest you get a baseline set of pictures at your current weight.
Next drop 5 pounds and retake the pictures.
Continue doing this at 5 pound intervals until your content with the shape of your abdominal wall.
You will then know what weight you need to maintain to have and abdomen Looks good.
Individuals who have excess visceral fat, are not good candidates for a tummy tuck, unless they first manage the visceral fat with successful weight loss.
The good news is, you can obtain a high-quality outcome with weight loss. 
Best,
Mats Hagstrom, MD

Will my muscles and fascia stretch again if I get a tummy tuck revision?

Answers (6)

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