Pseudobursa 2 years after tummy tuck? (Photo)

Question

Full TT in Oct 2021, w/ 1 drain removed at 2 weeks and 3 wks. While I no longer had sagging skin, I was still left with large bulge in my lower abdomen, noticeable in clothes. I asked my surgeon & she said it was remaining fat. 2yrs later, this bulge is now hard, isolated to my lower abdomen, has palpable ‘borders’ (where subcutaneous tissue density changes) & it is painful to touch firmly/manipulate. I’ve since had airsculpt, with hopes to remove it, but it persists. Thoughts?

J. Timothy Katzen, MD, FACS · Answer

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.

Daniel Barrett, MD · Answer

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

Camille Cash, MD · Answer

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.

Gerald Minniti, MD, FACS · Answer

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 .

Alan Gonzalez, MD, FACS · Answer

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)

Pseudobursa 2 years after tummy tuck? (Photo)

Answers (9)

Answer: Chronic Seroma

Answer: Chronic Seroma

Answer: Pseudobursa 2 years after tummy tuck?

Answer: Pseudobursa 2 years after tummy tuck?

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Pseudobursa 2 years after tummy tuck? (Photo)

Answers (9)

Answer: Chronic Seroma

Answer: Chronic Seroma

Answer: Pseudobursa 2 years after tummy tuck?

Answer: Pseudobursa 2 years after tummy tuck?

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Recommended reading

Everything you need to know about Tummy Tuck

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