Bulged and hard tummy, no much feeling after 11 months post surgery - permanent?

Question

I am a 43and I had a tummy tuck, liposuction, and breast augmentation last august. From the beginning my tummy was bulged but surgeon said it was normal due the procedure. I didn’t do much physical work and followed all the post surgery care directions. My tummy after surgery has never looked flat it’s hard and I have little sensation in the whole area. It looks swollen all the time and it worsen as the day goes on. By the end of the day I look like I am bloated but I am not. Is it permanent?

Alan Gonzalez, MD, FACS · Answer

Hello @aaquino79, thank you for your question and showing you pictures. I understand your concern. It is important to take into account several aspects among which is the surgical technique applied, and to evaluate if there is something else at a systemic level. The best course of action is to consult one or several board certified plastic surgeon for more information and options tailored specifically to your needs.  Best wishes! Alan Gonzalez MD, FACS.  American Society of Plastic Surgery Member (ASPS), International Federation for Adipose Therapeutics and Science” Member (IFATS), American Society of Plastic Surgery Member (ASPS), Colombian Society of Plastic Surgery member (SCCP)

J. Timothy Katzen, MD, FACS · Answer

Thank you for reaching out regarding your concerns about your bulging hard abdomen, which you noticed 11 months after your tummy tuck, liposuction, and breast augmentation. I appreciate you providing your medical history and sharing pictures for examination.
After reviewing your profile view, it appears that your abdomen is almost flat, and the bulge is not as prominent as you described. This could be due to your individual anatomy and the surgical repair performed. However, a revision may be considered if the bulge still bothers you. For a potential revision, I suggest focusing on additional muscle plication, particularly from the bellybutton to the pubic region. This approach should help flatten the abdomen when viewed from the side. It is essential to determine whether the abdominal muscles were adequately repaired during the initial surgery.
The numbness you're experiencing is likely a permanent outcome resulting from the surgery. This type of numbness is a common side effect, and your plastic surgeon should have explained this to you before the procedure.
In terms of bloating, it may be beneficial to consult with a registered dietitian to analyze your food intake. Certain foods can lead to bloating; a dietary assessment may help identify potential triggers.
I hope this response helps address your concerns about the bulging hard abdomen you've experienced 11 months after your tummy tuck. If you decide to pursue a revision, you must thoroughly discuss your goals and expectations with your plastic surgeon.
Best of luck in your journey towards achieving your desired results.
Sincerely,
Dr. Katzen

Daniel Barrett, MD · Answer

Dear aaquino79,
I understand your concern. However, without a proper assessment, it would be difficult to determine what is 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, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Scott C. Lindsay, DO · Answer

Thanks for your question! It could still be swelling this far out. However, I would suggest seeing your doctor or getting a second opinion to make sure nothing else is going on. Good luck!

Connie Hiers, MD, FACS · Answer

The sensation will not return since the sensory nerves were cut with the incision.  an examination will tell is the excess is fat and can be removed with liposuction. Liposuction could not be done in that area safely with the tummy tuck, but now can be done. If needed, an ultrasound can be done to see if you have an organized pocket of fluid, a seroma.  If present, it can be removed.

Camille Cash, MD · Answer

It's difficult to determine what is causing your concern.  It could simply be excess subcutaneous fat which could be addressed with liposuction.  It could be visceral/internal fat.  That is the fat that is behind the muscle wall that is not improved with a tummy tuck or liposuction.  That can be addressed through weight loss however.  An in person evaluation may lead to more specific answers for you.

Darryl J. Blinski, MD · Answer

Would be nice to see before photos because I think your bmi was easily over 30-32. This you either have excess lower abdomen fat, or larger amounts of internal visceral fat, or failed muscle repair or all above. Best yo obtain ultrasound of lower abdomen to try the rx this . 
Best yo virtual consult with….

Mats Hagstrom, MD (license on probation) · Answer

To make an assessment on the outcome of a plastic surgery procedure we need to see proper before and after pictures. If you don’t have before and after pictures and ask your surgeon to forward the pictures they took. Seeing your before pictures helps us understand your candidacy for the procedure, and that can help explain why results look the way they do. The most common reason patients have bulging after a full tummy tuck is individuals who have excess visceral fat. This creates increased in drop domino volume that cannot be contained with muscle tightening alone. Individuals who have excess visceral fat need to lose weight before the procedure in order to make themselves better candidates. There are four variables to determine what someone’s abdomen looks like. The four variables that determine what the abdomen looks like our excess Skin laxity typically due to previous pregnancies or weight loss. Excess subcutaneous, fat, muscle separation from previous pregnancies. Excess visceral or intra-abdominal fat. 
The tummy tuck primarily treats, skin, laxity, and muscle separation. If somebody also has visceral fat, then weight loss is needed in order to get a flat abdomen regardless of how well the tummy tuck is performed. Differentiating or determining if somebody has visceral fat problems is not rocket science and should be pretty easy and ideally should be addressed during in person consultations before scheduling surgery. If visceral fat is the issue, then weight loss should improve your results dramatically. 
Best,
Mats Hagstrom, MD

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