What could be the cause to consistent muscle hardness post tummy tuck? (Photos)

Question

18 months post tummy tuck I still have consist hardness, limp causing discomfort in my abs. Prior to the surgery I had three consultation with different consultants. All of which stated my abs were fine and no repair was required. I personally couldnt feel any separation. Fast forward to after surgery, the pain was horrendous as apparently I had 4 cm gap so repair was done. Ever since ive had internal lump and if a tense it bulge out above navel. My consultant has given no explanation

J. Timothy Katzen, MD, FACS · Answer

Hello Intellectual345835 in Cheltenham, and thank you for your question regarding the consistent muscle hardness, abdominal tightness, internal lump, and bulge around your navel following your tummy tuck.

Thank you for sharing your history and photos. The symptoms you're experiencing are likely related to the rectus abdominis muscle repair that was performed during your tummy tuck. Typically, this muscle repair is done from the bottom of the sternum to the top of the pubic region, using permanent sutures in a two-layer closure. The muscle hardness and other symptoms you're describing may be due to the tension and the nature of the permanent sutures used during the repair.

One possible solution to alleviate these symptoms is the removal of the permanent sutures. However, this could result in the muscles becoming gapped again, leading to a distended abdomen, particularly noticeable when standing. This means your belly could protrude more on your profile view.

Deciding whether to remove the sutures depends on how intense and debilitating your discomfort truly is. Removing the sutures might relieve the tension, but it comes with the risk of an altered abdominal contour. I recommend consulting with your original plastic surgeon to discuss these options further and to carefully consider how much the pain is affecting your daily life. Keeping a detailed notebook to track the intensity of your abdominal pain can also help in making this decision.

Good luck, and I hope this helps answer your question regarding the persistent muscle hardness after your tummy tuck.

Sincerely,

J. Timothy Katzen, MD, FASMBS, FICS

Daniel Barrett, MD · Answer

Dear Intellectual345835,
I understand your concern. However, without a proper assessment, it would be difficult to determine what is wrong. 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

Hampton A. Howell, MD · Answer

Hi.  Sorry to hear you're having issues after your surgery.  I would get another opinion from a reputable plastic surgeon as well as a general surgeon.  They might find a CT scan to be helpful depending on what they find on physical exam.
Good luck and take care, 
Dr. Howell

Jon S. Wilensky, MD · Answer

Consistent muscle hardness after a tummy tuck could be due to various factors, including inflammation, residual swelling, or muscle spasms. It’s important to consult with your surgeon to rule out any complications and discuss potential interventions or therapies to address the issue.

Jeremy S. Hurren, BSc, MBBS, FRCS (Plast) · Answer

It is not possible to give you a medical opinion on your problem based on limited information and photographs. You need an in person consultation with an examination. However, it possible to make some general comments about what is typical or may be possible, but you should not consider these a medical opinion on your concerns.
Al bulge following an abdominoplasty could be due various different things and that is why an examination is necessary and possibly radiological investigations such as an ultrasound scan or MRI may be required.1) muscle separation - divarication of the rectus muscles - often caused by pregnancy or obesity - usually treated with repair of the muscle layer during an abdominoplasty. If you have already had a repair a partial failure of the repair could result in a bulge especially with muscle tensing.2) A hernia - if you had a hernia in the midline then the bulge could be due to fat or bowel from inside your abdomen passing through a hole in the muscle layer. This is relatively unlikely after a rectus repair as hernias would usually be repaired during an abdominoplasty and the rectus repair would reinforce the hernia repair.3) Seroma - a serum is a collection of tissue fluid that can build up in the space left behind after an abdominoplasty. Seromas usually absorb away in the days or weeks after surgery but they can become permanent or chronic. Chronic seromas usually require surgery if they are to be removed. A collection of blood called a haematoma could cause a similar problem.4) excess fat under the skin - sometime people have a pocket of excess fat between the skin and the muscle layer - this is usually best treated with liposuction.5) something inside the abdomen - often fat, but enlargement of any organ from inside the abdomen or pelvis could push the abdomen out. eg pregnant uterus, fibroids etc. Usually this would be a more generalised bulge.6) natural body shape - some peoples natural body shape is one of a prominence of the abdomen.7) a lump or tumour in the abdominal wall could cause a bulge or lump.8) a combination of any of the above. 
I advise you to have an in person consultation with a suitably qualified and experienced plastic surgeon to discuss your concerns and what may be possible. I suspect that an ultrasound scan might be helpful in clarifying what is causing the bulge. You could ask your surgeon if they would consider referring you for a scan. An MRI scan might be helpful but an ultrasound scan is more dynamic. You can have an ultrasound scan standing up or while tensing the abdominal muscles which may help to give more information.
Best wishes

Camille Cash, MD · Answer

I'm sorry to hear of the discomfort you are still having after your tummy tuck.  Based on your photos and description it is best you visit with another surgeon for a second opinion.  It is not a situation that can be diagnosed with photos.  Further testing such as an ultrasound or CT scan may be helpful in identifying the underlying issue.

Douglas Taranow, DO, FACOS · Answer

Unfortunately, I would need to perform a physical exam to accurately answer your question.  An educated guess, I feel you did require a plication (very common to realize the rectus is loose while under anesthesia and open) and when you pull the center muscles closer, it may cause a bunching of the skin and fat in the central region.  If your 'lump' is soft, it is excess fat which may be liposuctioned.
I would go for another consultation from a board certified plastic surgeon for a second opinion.
Best wishes,
Dr. Taranow

Mats Hagstrom, MD (license on probation) · Answer

To assess the outcome of a plastic surgery procedure we generally always need to see proper before and after pictures. If you don’t have before, and after pictures, then ask your surgeon to forward the pictures they took.
The most common reason the bulging of your abdomen after this procedure is the presence of excess visceral fat.
Weight loss will reduce excess visceral fat.
Without understanding your candidacy for the procedure in the first place, it’s hard to make an assessment on the outcome.
I suggest having a few second opinion, in person, consultations with other providers in your community.
Mats Hagstrom MD

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