Does a tummy tuck not work for some people? I am 11 weeks post op from a full TT and muscle repair. (Photos)

Question

At 6 weeks I looked pretty flat coming out of my binder, but am increasing in a below navel bulge weekly. My doctor told me to wear my binder for an additional month, but every week it has continued to look larger, not smaller. I am also very actice-an avid cross fitter who started back at modified intensity at the 6 week mark. Is this normal swelling for an active individual or could my internal stitches have come undone? Thank you!

Ankur Mehta, MD · Answer

Hello and thank you for posting photos along with your question. If your abdominal muscles were tightened then you should see a significant difference before and after the tummy tuck. Tightening of the abdominal muscles is the strongest tool for flattening the stomach. If you felt as though you were flat at the 6 week mark and started noticing a gradual recurrence of the lower abdominal bulge then I would be concerned that the repair of the lower abdominal muscles is stretching back out and not holding. Personally, I am very conservative with my patients post operative recovery and if I have someone that does crossfit I would not let them go back to it until at least 3 months!!! I let my patients slowly work back up to lifting weights and things like that after 6 weeks but no core/abs until 3 months. The other potential is a seroma (fluid collection). I would be curios to know if you had drains, how long and how much were they draining before being pulled. Hopefully you have seen your plastic surgeon to discuss this finding with him. I have an open door policy with my patients and encourage them to come in to the office if they ever have concerns or any issues. I hope this helps and wish you the best of luck.

Tom J. Pousti, MD · Answer

I'm sorry to hear about your understandable concerns after tummy tuck surgery.  Yes, it is possible that tummy tuck surgery "does not work" (the patient does not achieve the desired outcome). As you likely know, your plastic surgeon will be your best resource for precise diagnosis, advice, and the most meaningful reassurance...
Generally, abdominal wall "swelling" after tummy tuck may be related to:

1. Swelling in the soft tissues.  This may take several months to resolve and may worsen with increased activity  or at the end of the day.   Patience  is required to allow for resolution of the swelling. The swelling occurs because of the interruption of venous and lymphatic channels that occurs during the tummy tuck operation.
Often patients will like their “flatness” immediately after surgery; then, these same patients are disappointed for a period of time once swelling of the tissues occurs. In the longer term (this may take several months and even up to one year), the swelling dissipates and the skin of the abdominal wall "redrapes"  over the smaller underlying  musculoskeletal framework (where the abdominal wall muscles have been brought together again in the midline). 
Often, patients will report that the swelling increases as their activity level increases and gets worse later on in the day. Sometimes, the use of compressive garments may be helpful to control the edema. The swelling resolves many months (and even beyond one year post op in some cases) as the lymphatic and venous systems begin functioning normally.

2. Fluid accumulation in the space between the skin and the abdominal wall muscle.  this may consist of blood ( hematoma)  or serum (seroma).  This fluid accumulation can generally be diagnosed by physical examination ( occasionally ultrasound  may be helpful).  Treatment consists of aspiration;  several episodes of aspiration may be necessary.

3. Separation of the abdominal wall muscle repair may lead to a swelling/bulge appearance. This may be diagnosed on physical examination  with your surgeon examining you in different bodily positions. One of the steps of a tummy tuck procedure involves reapproximation (plication)  of the rectus muscles.  These muscles have spread apart during pregnancy and/or weight gain. Bringing them together again in the midline helps to “tighten” the abdominal wall as well as to narrow the waistline.

***Based on your photographs and description, I would be concerned that separation (to some degree) of the abdominal wall muscles MAY be causing your abdominal wall distention. This may be diagnosed on physical examination with your surgeon examining you in different positions (your plastic surgeon will be in the best position to accurately advise you and/or provide you with accurate assessment and/or meaningful reassurance.

If abdominal wall laxity is the "culprit" for ongoing abdominal wall distention, re plication may be necessary down the line.

4. Residual adipose tissue may be confused for swelling. Again this is most easily diagnosed by physical examination. Additional liposuction surgery maybe necessary to improve the results of surgery  in some cases (this factor does not seem to be likely in your case).

Generally, it takes many months for swelling to resolve after tummy tuck surgery and it may take up to one year (or greater) for complete skin redraping  to occur.

I hope this helps.   Best wishes for an outcome that you will be pleased with longer-term.

Rukmini S. Rednam, MD, FACS · Answer

Hello Gymbean 02,I can understand your concern looking at your photos.  To answer your questions simply no.  A tummy tuck should work for all people as long complicating factors like a large hernia or healing issues are not present.  But, that being said, things can tear or stretch out causing changes in your results.At 3 months some swelling is expected especially in the lower central area but having noticed a significant change from your early results I would recommend bringing this to the attention of your plastic surgeon.  Having a very active lifestyle as a cross fitter it could be swelling alone, or a fluid collection, or it may be that something has stretched-out from your internal repair.  The only way to determine this is with an in person exam.  If this is swelling it will resolve in time.  If it a fluid collection it may need to be drained and if this is due to stretched out or torn deep stitches this may need to be readressed around at least 6 months post surgery to allow for healing before revision.Best of Luck!Dr. Rednam

Paul B. Mills, MD · Answer

Tummy tucks or mini-tummy tucks can take months for the shape and contour to improve.  I make sure that patients know that even normal activity will increase the swelling significantly initially and then to lesser degrees as time passes.  However, you have enough prominence of your lower abdomen that I might be concern about a seroma or fluid collection that would produce more significant protrusion of the lower abdomen. Follow up with your plastic surgeon for evaluation and good luck!

J. Joseph Danyo, MD · Answer

It's common and normal to be swollen more after a few weeks post op from abdominoplasty than the first week or two. This is because as you become more active gravity and activity pull more swelling into the tissues. It is also possible to disrupt the muscle repair post op.  At 4months post op you'll have a better sense of your true result.

Does a tummy tuck not work for some people? I am 11 weeks post op from a full TT and muscle repair. (Photos)

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Does a tummy tuck not work for some people? I am 11 weeks post op from a full TT and muscle repair. (Photos)

Answers (5)

Answer: Swelling after tummy tuck

Answer: Swelling after tummy tuck

Answer: Abdominoplasty results

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Our mission is to create a world where every investment in modern beauty is Worth It.