Concerns over muscle stretching 2 years post abdominoplasty (Photo)

Question

48 y/o male- full tummy tuck about 2 years ago. Prior to that gastric sleeve surgery and lost 35kg (77 lbs). Everything went pretty well, I'm happy with my scar and the results were great. Over lockdown I put on 12 kg (26.5lbs). I've lost most of it again but my mid section always feels "bloated" and is distended. I'm wondering if I have done any damage to my abdominoplasty? Previously it always stayed flat but now it feels "not right". Thanks, Scott.

Daniel Barrett, MD · Answer

Dear SCAUST,
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

J. Timothy Katzen, MD, FACS · Answer

Thank you for your detailed history and the accompanying images. First and foremost, kudos on your impressive 77-pound weight loss post-gastric sleeve!
Based on the provided information, it appears that while your abdomen's skin and subcutaneous fat remain relatively unchanged, the main issue lies in the visceral fat behind your rectus muscle. This fat surrounds your internal organs, and with the weight gain, it seems to be pushing out your rectus abdominis muscle, leading to a distended appearance.
Here's a suggested plan of action:
Weight Loss: Aim to shed the gained 26 pounds. There are effective medications like Mounjaro and Ozempic that can support this effort. Post weight loss, we can reassess your abdominal region.
Muscle Repair: If, after losing weight, your abdomen remains distended, it may be beneficial to consider muscle repair. Using your prior tummy tuck incision, a surgeon could repair the muscle from sternum to pubis. Suturing the internal oblique muscles might further fortify your abdominal wall.
Mesh Application: If muscle plication alone doesn't suffice, applying a mesh over the abdominal wall can offer added support and help achieve a flatter appearance.
Always remember, the primary step should be weight reduction. Depending on the results post weight loss, surgical intervention can be contemplated.
Wishing you all the best in your continued health journey!
Sincerely,
Dr. Katzen

Gary M. Horndeski, MD · Answer

You would benefit from a repeat tummy tuck. I recommend an abdominoplasty with mesh reinforcement. The mesh creates a more flatten abdomen by compressing the abdominal wall resulting in early satiety and helps maintain a reduced weight.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Martin Jugenburg, MD · Answer

Hello, thank you for your question. Yes muscles can stretch after a muscle repair tummy tuck. This can especially happen if we are not as active as before and weight gain. If this is an issue for you as far as discomfort you should speak to your family doctor about obtaining diagnostic tests, sometimes a hernia can occur and give you those feelings.

Carmina Cardenas, MD · Answer

During a Tummy Tuck, the extra skin is removed and also the muscle tighten, but both tissues (muscle and skin) are totally elastic and you gained those 27 lbs inside of the abdominal cavity as visceral fat, and nothing surgically to do but losing weight. 
Be encouraged. 
Dr. Cárdenas

Connie Hiers, MD, FACS · Answer

Even with 25-pound weight gain, you should not be this bloated. Have your medical doctor check you for food allergies.  Most of your weight gain is probably internal. Try losing the 25 pounds.

Felix Omar Márquez, MD · Answer

Hello, thanks for your question and photo. As you may know, it will be necessary to have a physical exam before giving an opinion. It seems that you gained weight. Please consult a board-certified plastic surgeon in your area. Good luck!

Camille Cash, MD · Answer

I encourage you to return to your surgeon for an evaluation of your concerns.  It could be that the muscle repair has failed, it could be from visceral fat, or there could be another cause.  Your surgeon should be able to point you in the right direction after an examination.

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