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

A chronic seroma should be easily identified by physical examination. Any doubt should be confirmed by high resolution ultrasound, a device all plastic surgeons should have in their office today. Anyone offering you 'airsculpt' sounds suspicious, i.e. not a real surgeon. You should seek second opinions from surgeons capable and expert in primary and revision body surgery .

Hello @whitneybutts, 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)

I would start with an in person exam to assess your soft tissues and abdominal wall. I would likely get an ultrasound to rule out a seroma. If no seroma was identified, and your physical exam suggested an abdominal wall problem, I would consider a CT scan to assess your abdominal wall or explore with 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.

I encourage you to return to your surgeon for an assessment. An examination and further testing may be indicated, such as an ultrasound, in order to determine what may be causing your concern.

It would be nice to see your preoperative photographs. I can see the area you are concerned with, but your overall result is pretty good. Other than that lower abdominal segment.

YourIt would be nice to see your preoperative photographs. I can see the area you are concerned with, but you’re overall result is pretty good other than that lower abdominal segment.

Your incision extends rather far to the side, suggesting you had substantial weight loss.

Diagnostic studies, such as an ultrasound or MRI or CT scan could further delineate the nature of your lower abdominal problem. Of course physical exam with clear role as well.

This could be caused by some persistent fat that could be addressed by liposuction. There is a little extra skin that could be resected at the same time with a relatively minor, tummy tuck revision, or there may be a seroma cavity that has matured requiring resection, or you may have some recurrent abdominal muscle looseness.

All of these are correctable, but would not be prudent to move forward without some additional information and imaging studies.

And, by the way, none of these suggest a clinical or surgical error.

There are four tissue variables that determine what the abdomen looks like. If somebody doesn’t like the way, their abdomen looks that it is usually because of one or more of these for tissue variables. A good plastic surgeon should not have much difficulty differentiating which tissue layers are causing the problem. The four tissue layers that determine what the abdomen looks like are abdominal skin laxity, excess subcutaneous fat, Muscle separation from previous pregnancy, excess visceral, or intra-abdominal fat.
You didn’t say much about the pseudo Barsa or encapsulated seroma. That could potentially be an issue, but it can usually be picked up on examination. The definitive test for out a fluid collection whether chronic or acute would be an ultrasound. It’s also not certain if your pictures represent your abdomen it before or after your liposuction?
An experienced plastic surgeon should be able to differentiate between the tissue layers and tell you why your abdomen looks the way it does. A straight abdominal wall should make a bee lineup between the sternum and the pubic bone. Bulging of the abdominal wall typically represents insufficient, muscle tightening or excess visceral fat.
If the muscle wall is straight, and the abdomen still bulges, then subcutaneous fat is most likely the culprit.
Differentiating these variables isn’t rocket science and a good surgeon should be able to tell you what can or cannot be accomplished with revision procedures. Whenever making an accurate assessment on the outcome of a plastic surgery procedure, we generally recommend patients show a complete set of proper before and after pictures. If you don’t have before, and after pictures and ask your surgeon to forward the pictures they took.
Best,
Matt Hagstrom, MD