Why is my mid-section rounded and protruding a year after a Tummy Tuck with muscle repair?

Question

I had a tummy tuck with muscle repair 1 year ago. The muscle was (as I was told) pulled as tight as possible. However, I have a very rounded belly, mid way in my stomach. Flat elsewhere. The muscle seems to push outward. Could there be fat behind the muscle or something with my intestines? I may have gained a few pounds over the past year but nothing significant. (3-5 pounds) if at all. Please help before I go back.

Marwan R. Khalifeh, MD · Answer

You may have developed "visceral" or omental or submuscular fat (all terms can be used).  this fat bulge from beneath the muscles and exerts pressure on the muscles, which can create such a bulge.stitches can repair the muscle, but if there is constant pressure, over the years (sometimes months), the bulge can return.your best options are to eliminate the few lbs of weight loss to get that visceral fat as small as possible.explore the existing repair with your surgeon, but don't rush into more surgery before controlling the few pounds via diet and excercise.

Mark Crispin, MD · Answer

Pictures would be helpful.  Did your abdomen loosen up after some time or did it look rounded day 1 after the surgery?  At times the muscle repair may loosen and require repair once again.  Fat under the muscle can cause a belly to look rounded.  This is an easy diagnosis for your surgeon to make.

John Michael Thomassen, MD · Answer

Intraabdominal fat cannot be removed or liposuctioned and may result in a round contour even after abdominal fascial plication.  Another possibility is that the plication sutures have dehisced.  In this case you would have noticed a gradual loss of contour with time.

Brent Birely, MD · Answer

Some people deposit their fat in the subcutaneous layer, beneath the skin but above the level of the muscles.  Others will deposit fat intra-abdominally, deep to the muscles, in the abdominal cavity where all of their internal organs are located.  Patient who have a significant amount of intra-abdominal fat are unable to have their muscles tightened to any significant degree due to the volume of tissue inside of the abdominal cavity, and the limited space for all of those contents to exist.  This results in a person still having a rather round abdominal contour despite having had the muscles tightened.  The only way to get rid of excess intra-abdominal fat is through weight loss, unless it is so severe that a person needs gastric bypass surgery.

Christopher Saunders, MD · Answer

I agree with the other doctors who have responded so far. Possibilities include intra-abdominal fat and muscle repair weakness or separation. Physical examination should help figure out about the muscle repair as described below.Contract your abdominal muscles when lying down. This might be best done by doing half a sit-up or stomach crunch. At this time, squeeze your excess skin and fat. How much is there? More than an inch? Small or large amounts of fat?This position will also evaluate the muscle repair. Weak muscles will allow abdominal contents to protrude and you should have less fat there. I have seen people do this and squeeze only tiny amounts. This means it is abdominal fat and muscle weakness. Others will find quite a bit of fat.The one option I did not see in the responses is liposuction. It is not uncommon that a little liposuction, just in the problem area, can do the trick. It's easy and inexpensive. If the area is small, it can be done with local anesthesia.Get checked by your doctor. He can help. I hope this helps.Dr Chris Saunders

Al Farabi L. Jaafar, MD · Answer

Hi. Follow up with your surgeon. A simple physical exam will determine if the midline repair held or gave way. There are many factors that can cause dehiscence. Early physical exertion is one.

Rick Rosen, MD · Answer

thank you for your question. I believe that would best be answered with a consultation with your original surgeon or a different one. Photos would help us give you an idea. It is possible that the muscle repair has weakened or torn since your procedure. It is possible that your muscles have weakened without the normal exercise during your healing. Both can be answered with an examination. Good luck.

Robert E. Zaworski, MD (retired) · Answer

Would love to see your before and after photos.  The problem could be internal (visceral, intestinal) fat from being overweight.  Discuss your results with your surgeon in the event a revision is needed.  Best wishes!

Why is my mid-section rounded and protruding a year after a Tummy Tuck with muscle repair?

Answers (8)

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