Pseudobursa 2 years after tummy tuck? (Photo)

Hello, and thank you for your question regarding the hard, persistent bulge in your lower abdomen two years after your full tummy tuck. I appreciate the detailed history, and based on your description and photos, what you’re experiencing could very likely be a pseudobursa.

A pseudobursa is a pocket of thickened scar tissue that forms between tissue planes after surgery — most commonly in areas where there's been prolonged fluid buildup (like seromas) or motion-related friction. This space can become walled off and feel like a firm, defined mass. It’s not dangerous in itself, but it can be uncomfortable, resistant to fat removal procedures like Airsculpt or liposuction, and very frustrating because it mimics a “bulge” that can appear like fat or fullness in clothing. Importantly, pseudobursae often develop exactly where you described — in the lower abdomen — especially if the area was slow to heal or had fluid accumulation post-op, even if mild.

Because the tissue is scarred and fibrotic, it does not respond well to nonsurgical treatments like massage, fat melting, or even liposuction. In fact, airsculpt or liposuction can sometimes make the fibrosis worse if the tissue isn’t properly excised. If a pseudobursa is suspected, the best next step is to obtain imaging, such as an MRI or ultrasound, to define the structure, rule out any residual fluid, and confirm the diagnosis.

If imaging confirms a pseudobursa, the definitive treatment is surgical excision. This typically involves a revision tummy tuck or localized surgical revision, during which the scar capsule is opened, the thick fibrous tissue is removed, and the tissue layers are re-adhered properly to eliminate the space. When done carefully by an experienced plastic surgeon, this can flatten the area, relieve discomfort, and improve the contour significantly.

You’ve done the right thing by observing, asking questions, and even attempting a less invasive solution. But since the bulge has persisted — and especially since it’s painful to touch and has well-defined borders — it’s time to have it evaluated by a board-certified plastic surgeon with experience in revision abdominoplasty and post-surgical complications like pseudobursae.

Wishing you clarity, relief, and a smooth path to feeling like yourself again.

Sincerely,
Dr. J. Timothy Katzen, MD, MBA, FASMBS, FICS
(Certified by the American Board of Plastic Surgery and President of the American Society of Bariatric Plastic Surgeons; Fellow of the International Society of Aesthetic Plastic Surgery, American College of Surgery, International College of Surgery, and American Board of Metabolic and Bariatric Surgery; Member of the American Society of Plastic Surgeons, American Academy of Cosmetic Surgery, and RealSelf Hall of Fame)

Be sure to bring your full surgical history and any photos to your next consultation, and ask your surgeon to evaluate you for a pseudobursa specifically — the right diagnosis is the first step toward the right solution.

Dear whitbv,
I understand your concern. However, without a proper assessment, it would be difficult to determine what is wrong. You will probably need an ultrasound to see is there a pseudobursa. 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

Ask your surgeon to do an abdominal ultrasound to see what this is. If it is a burse, it may need to be removed.