Stomach Was Flat After Diastasis Repair Surgery, Now it is No Longer Flat 6 Weeks After, Something Wrong? (photo)

Question

I am a young super fit young woman who has had two children. I have had diastasis repair surgery 6 weeks g ago and whilst post surgery my tummy looked pretty flat it does not really look that way. Why could this be? i wonder if things have gone wrong? How would i know if this is the case. I am so worried, and wonder if i should start doing some pilates to strengthen the area?

Peter A. Aldea, MD · Answer

Respectfully, in your before picture you have an accentuated lower back curve (lordosis) resulting in accentuation of the protuberance of the tummy while in the 6 weeks after pose your lower back is much straighter. Despite this discrepancy, there is a significant improvement in the flatness of the tummy. 

	If you have ANY questions regarding your repair you really should be seen by your surgeon and have him advise you. No opinion posted by anyone on this forum can come close to the information obtainable by a physical examination especially if done by the original surgeon.

	good Luck.

	Peter A Aldea, MD

Steven Turkeltaub, MD · Answer

Your photos, unfortunately, are not entirely clear as they are of low resolution. The protuberance that you are having now at 6 weeks post tummy tuck can be related to swelling, fluid accumulation or even partial disruption of the repair. You should contact your plastic surgeon to have him/her examine you and explain exactly what is going on right now.

Tom J. Pousti, MD · Answer

Thank you for the question and pictures.

	The best course of action is not to start Pilates but to see your plastic surgeon for direct examination. He/she will be in the best position to make a diagnosis and recommendations.

	Generally speaking 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.

	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 &ldquo;tighten&rdquo; the abdominal wall as well as to narrow the waistline.

	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.
	Generally, it takes many months for swelling to resolve after tummy tuck surgery and it may take up to one year  (or greater)  a complete skin redraping  to occur.

	I hope this helps.

Donald Nunn, MD (retired) · Answer

You are still early in the post op period and some component of the tummy appearance is due to swelling in the area. That said, you should discuss this with your surgeon to determine what was done with the fascia at time of surgery and your concerns. Donald R. Nunn MD Atlanta Plastic Surgeon.

Michael S. Hopkins, MD (retired) · Answer

The flatness of the stomcah after surgery is dependent on a number of factors.  These include the type of repair, disruption of the repair or the suture material, the fullness of the abdominal cavity (how much abdominal organs  one has to fit into a limited area), etc. 

	Your before and six week after photos from the side view show that there is significantly less bulging afterward, but not completely flat. I have not found this to be unusual in thin, petite women such as your picture indicate.  At six weeks, there is still some swelling, but I do not think it accounts for all that we see.

	Talk to your surgeon to make sure there is no problem and don't panic.  You have a good result and it will likely get better as swelling resolves.

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