Doctor Says It's the Muscle Sticking Up, and Appears to Have Neither Any Idea Why nor if It Will Always Be Like That? (Photo)

I am 3.5 weeks post TT, and I have a bulge just below the right side of my ribcage. My plastic surgeon examined it a few days ago and said it wasn't fluid, it was the muscle sticking up. She said maybe I was asymmetrical before surgery (no I wasn't!) and that maybe it would go down a bit with time and exercise, but "at least it looks better than it did before." Not comforting. Is this going to require a revision later? Is it even worth the hell and money? She didn't mention revision.

Doctor Answers 10

At three weeks waiting is your best option

The small upper bulge could be fluid, swelling, or asymmetry in the skin flap. At just three weeks it can be hard to tell, and most often these imperfections resolve on the their own. Waiting is best.

Chicago Plastic Surgeon
4.0 out of 5 stars 42 reviews

Post op bulge in upper abdomen

There are a number of possibilities that come to mind 

  • fluid--blood (hematoma) or serum (seroma)
  • swelling, which can be asymmetric
  • uneven fat pad
  • uneven muscle repair or failure of muscle repair
  • pre-op asymmetry.

If there were fluid, some early attention to this would be in order. Among the others, most would advise no treatment until 6 months, expecting a likelihood of improvement as swelling resolves. 

All the best. 

Jourdan Gottlieb, MD
Seattle Plastic Surgeon
4.6 out of 5 stars 45 reviews

Doctor Says It's the Muscle Sticking Up, and Appears to Have Neither Any Idea Why nor if It Will Always Be Like That? (Photo)

You need a scan to rule out a hernia/split muscle/seroma/combo. Than if just fat the area could be liposuctioned. If other reasons than re operation could be indicated. 

Darryl J. Blinski, MD
Miami Plastic Surgeon
4.6 out of 5 stars 173 reviews

Concerns after tummy tuck

It's too early to get worked up about the asymmetry. My guess is that there is a little difference in the thickness of the abdominal fat in that area which is most likely due to swelling at this point. It's ok to express you concerns but be patient.

Ronald Schuster, MD
Baltimore Plastic Surgeon
4.9 out of 5 stars 77 reviews

Swelling of the upper abdomen following an abdominoplasty

A small bulge in the upper abdomen could only be swelling or residual fat.  It is very unlikely that this is a muscle bulge.  

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 19 reviews

Is this muscle bulge

It is hard to determine exactly what is causing your problem. Your surgeon could order an ultrasound to verify that it is not a pocket of fluid. If not, I would agree with others who recommend that you wait 3 to 6 months before considering any additional surgery.

Don W. Griffin, MD
Nashville Plastic Surgeon
4.8 out of 5 stars 72 reviews

Upper Abdominal Bulge after Tummy Tuck

It is way to early to say whether this upper abdominal fullness below the rib cage will be a persistent aesthetic problem or not. This will be more apparent at 3 and absolutely at 6 months after surgery. It is too early to have an idea if this will turn into the need for a revisional surgery or not.

Barry L. Eppley, MD, DMD
Indianapolis Plastic Surgeon
4.7 out of 5 stars 72 reviews

Asymmetry three weeks after abdominoplasty is not necessarily reason for concern.

I can't say from the photograph the source of your problem. I do know that there is still swelling of the abdominal wall at your stage of convalescence. There will be significant changes as the swelling subsides.

Vincent N. Zubowicz, MD
Atlanta Plastic Surgeon
4.7 out of 5 stars 35 reviews

Swelling after Tummy Tuck?

Thank you for the question.

As always, it is best to be seen in person ( by your plastic surgeon) for precise diagnosis and treatment.

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 “tighten” 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.

If, several months from now, you still have the abdominal wall asymmetry and feel “dissatisfied” with your plastic surgeon's responses, best to seek in person second opinion consultations with board-certified plastic surgeons in your area.

I hope this helps.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,488 reviews

Asymmetric fullness after tummy tuck


Thank you for the question and the photos.  There are a handful of possible sources for the fullness that you have highlighted including excess fat, seroma, asymmetric undermining, asymmetric abdominal wall tightening, or prior asymmetry.  Your options at this time is to wait and reassess the progress with photos versus camoflouge (liposuction) versus full tummy tuck revision.  I suspect that at this time your best option is to wait longer and then consider liposuction if some residual asymmetry persists.

All the best,

Dr. Remus Repta

Remus Repta, MD
Scottsdale Plastic Surgeon
4.9 out of 5 stars 162 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.