Hard lump 6 months after lipo? (Photo)

Question

I had ultrasound liposuction on my abdomen just 6 months ago, and there are some areas under my skin that are still protruding. It doesn't feel like fat, and it has definitely shrunk after some compression and 2-3 lymphatic massages. However, it's still there and I'm not sure how to get rid of it. It feels more like a solid mass than fat, and I'm not sure how to get rid of it. The first 2 pics are before lipo, next 2 right after lipo, last 2 are today.

J. Timothy Katzen, MD, FACS · Answer

Hello LK1223. Thank you for your question regarding the hard lump you've noticed six months after undergoing ultrasound liposuction on your abdomen.

Thank you for providing detailed pictures and a history of your procedure. It's great to hear that there has been some reduction in the size of the lump after compression garments and lymphatic massages, but I understand your concerns about its persistent nature.

The lump you're describing could be due to several factors:

Scar Tissue Formation: This is a common occurrence after liposuction where the body's healing process leads to fibrous tissue buildup.
Seroma or Hematoma: These are accumulations of fluid or blood, respectively, that can occur after surgical procedures. While these typically resolve with time, persistent cases might require medical intervention.
Underlying Muscle Protrusion: Given the location and the firmness, there is also a possibility that what you're feeling could be related to the underlying muscle structure.
Diagnostic Steps:

Ultrasound or CT Scan: To accurately determine the cause of the lump, further imaging with an ultrasound or CT scan is advisable. This will help identify whether the lump is due to scar tissue, fluid accumulation, or other anatomical issues.
Treatment Options:

For Scar Tissue: If the lump is indeed scar tissue, injections of steroids or 5-fluorouracil (5FU) can help dissolve the fibrosis and reduce the lump.
For Seroma or Hematoma: Persistent fluid collections might need to be drained with a needle under sterile conditions by your surgeon.
Diet and Exercise: If the mass is related to residual fatty tissue or deeper visceral fat, enhancing your weight loss efforts through diet, exercise, or medications like Ozempic or Zepbound may provide improvement.
Consideration for Tummy Tuck: If the issue is due to underlying muscle or fascial weakness, especially below the belly button, a tummy tuck might be considered to tighten and flatten the abdominal muscles and fascia.
Next Steps:

Follow-up with Your Surgeon: It is crucial to keep your surgeon informed about this issue. They can provide specific recommendations based on your individual case and the results of further diagnostic tests.
Seek a Second Opinion: If you feel unsure about the advice or treatment plan from your current surgeon, seeking a second opinion from another board-certified plastic surgeon can provide additional insights and reassurance.
Your proactive approach with compression and massage was appropriate, and continuing to monitor the lump while exploring these diagnostic and treatment options will be key to resolving the issue.

I hope this information helps, and I wish you the best of luck in addressing and resolving the hard lump post-liposuction.

Sincerely,

J. Timothy Katzen, MD, FASMBS, FICS
Plastic Surgeon

Semih Yildiz, MD, FEPOBRAS · Answer

At 6 months after ultrasound-assisted liposuction, a firm or protruding area can still be from healing tissue, swelling, scar firmness, fat necrosis, or a small organized fluid/blood collection. The fact that it has become smaller with compression and lymphatic massage is reassuring, but a persistent solid-feeling lump should be examined rather than treated by guesswork.

In the photos, the abdomen looks improved compared with the before and early postoperative views, but there is still some lower abdominal fullness and contour unevenness. Photos alone cannot tell whether that is residual swelling, firm scar tissue, a fluid pocket, or remaining fat.

I would see your original surgeon, or another board-certified plastic surgeon if needed, for an in-person exam. If the area feels like a discrete mass, an ultrasound can be very helpful because it can distinguish scar/fibrosis from a seroma, hematoma, fat necrosis, or other tissue change. Treatment depends on that finding: time, compression, gentle massage, and sometimes lymphatic therapy may help swelling or firmness, while a fluid collection, fat necrosis, or a true contour irregularity needs a different plan.

Do not do aggressive massage, injections, or revision liposuction until you have been examined. Seek care sooner if the area is enlarging, red, warm, increasingly painful, draining, or associated with fever. Many firm areas continue to soften between 6 and 12 months, so revision decisions are usually delayed until the tissues are more mature unless there is a specific treatable problem.

Dana Goldberg, MD · Answer

The hard lump most likely represents scar tissue that formed because of a seroma after your liposuction. A seroma is a collection of fluid that is present for so long that the body forms a scar tissue layer around it. Eventually, the fluid is absorbed, but the scar tissue lump remains. It can contract and pull the skin in ways that create diets and bulges. Unfortunately, surgical removal is the best way to address this. This would involve a scar similar to a tummy tuck or C-section.

I’ve tried cool, sculpting and other modalities like steroid injections for this issue, but it is not a complete solution and sometimes doesn’t improve the situation at all.

If you haven’t gotten any opinion of your original, original surgeon, that’s the first place to start. If you feel ignored or have lost confidence in your surgeon, I recommend an in person opinion with the Board Certified plastic surgeon who specializes in body contouring.

Camille Cash, MD · Answer

Without an exam it's difficult to determine what comprises the contour that concerns you.  It could be scar tissue, residual fat, a seroma, or something else.  I encourage you to return to your surgeon for an evaluation.  She/He should be able to provide opinions after an exam.

Connie Hiers, MD, FACS · Answer

Ask your surgeon to order an ultrasound of your abdomen to see if there are pockets of fluid still present. If so, they can be drained by the radiologist or surgeon.

Serkan Kaya Ekinci, MD · Answer

Hello, I am Dr. Serkan Kaya Ekinci. As after the classical liposuction surgery; The edema and swelling that existed in the early period is replaced by production over time, and this efficiency decreases over time, and the tissues reach their original consistency after 3-6 months. Initial reproduction occurs after the third month. then it gradually decreases. In fact, we recommend that you get the final result for up to 1 year. My suggestion for you is that you keep in mind that the swelling will continue to decrease and the thinning will continue day by day. As far as I can tell from the photos, there is no problem. If it bothers you very much, it would be beneficial to see your doctor friend who performed your surgery. I hope I could help you.

Mats Hagstrom, MD (license on probation) · Answer

Your Liposuction results look fairly typical and I don’t see anything that’s clearly wrong in your outcome.
I suggest you follow up with your provider and discuss your concerns with him or her.
Best,
Mats Hagstrom MD

Hard lump 6 months after lipo? (Photo)

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