7 months post TT, asymmetry in hips and lump by incision. Should I be concerned about rupture? Will I need a revision? (photos)

Hello and thank you for your question regarding asymmetry in your hips and a lump near your tummy tuck incision at seven months post-surgery.

Based on your history and photos, most plastic surgeons would recommend revision surgery if the asymmetry in your hips and the lump are bothersome to you. The revision could include extending the incision to address the dog ear on your hip, which would help improve symmetry.

The lump near your incision could be due to a variety of causes, such as a seroma or a retained hematoma. At seven months post-surgery, it is highly unlikely for this lump to rupture. Revision surgery would likely involve removing the scar tissue and addressing the lump. This procedure could be combined with the hip asymmetry and dog ear correction to achieve a more harmonious result.

I hope this provides clarity regarding your concerns and potential next steps. Please consult with an experienced, board-certified plastic surgeon to ensure the best care and outcome.

Sincerely,
J. Timothy Katzen, MD

Dear sarahcam1983
Thanks for sharing your photos and your question. Unfortunately there is no zoom out photo of your abdomen. just looking at these photos I think you still have some excess skin and excess fat on your hips. It seems your original surgery was a bit conservative. I would recommend to let 12 months pass from your surgery and then consider a consult with a UK trained plastic surgeon with experience of revision abdominoplasty to assist you.I hope you find this answer helpful.

Dear sarahcam1983,
I understand your concern. However, without a proper assessment, it would be difficult to determine what went 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, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

An examination is needed to be certain, but you could have some liposuction and if needed, extend the side incisions to pick up more skin. Your surgeon can discuss what could be done.

An in person evaluation is always best, but it does appear from your photos that some revision may be beneficial. You appear to have some excess fat and skin at the hip area. It also appears you would be a candidate for scar revision. Further exams and/or testing would be needed to determine the recommendation for the lump that concerns you.

The posted photos barely demonstrate the full frontal view of the rather poorly done full TT. Appears as bilateral dog ears, severe. "Rail Road " track suture techniques, poor surgery closure. Excess fat, with unknown mass in mid incision. First obtain an ultrasound of mass in lower abdomen to see if seroma, or scar/fat tissue. In my office I offer ultrasound examination fee $500. Then Full revision of complete TT scar wit extension to remove dog ears, the lipo 360. Fee $10,000. Best to virtual consult with...

I appreciate your attempt at including before and after pictures. It is however far better when it comes to making an assessment to do so using quality images. Ask your surgeon to forward your before and after pictures and use those for reference when it comes to making an assessment of your outcome.
The fullness in your lower abdomen it needs to be checked to make sure it is a fluid buildup.
A fluid buildup called a seroma happens if drains are not used or if drains are removed too soon.
You can often diagnose a fluid collection because it’s like a bag of water or waterbed mattress. you push one area and the other area expands.
It can also be diagnosed using an ultrasound.
If it’s a fluid collection then it’s a little too late to treat it effectively without surgery.
Based on your pictures you probably needed an extended tummy tuck or more aggressive liposuction on your sides.
Plastic surgeons often do some liposuction in conjunction with a tummy tuck.
To treat the hips waist and back appropriately patients need to be turned either on their side or face down.
Most plastic surgeons will not go through the process of turning a patient during surgery unless absolutely necessary.
If done in conjunction with a tummy tuck the liposuction needs to be done first because after the tummy tuck it’s not possible for the patient to lay on their abdomen.
Turning a patient under general anesthesia is cumbersome and not particularly popular with the nursing staff or anesthesiologist.
It can take 30 minutes or longer and typically requires six personnel to turn a patient safely in the operating room.For that reason most surgeons do liposuction with patients laying on their back which significantly hampers the ability to contour the torso correctly.
There are also some safety concerns regarding blood supply when doing aggressive liposuction in conjunction with a full tummy tuck.To get your torso looking proportionate without your current “dog ears”(that is the correct medical Termanology for fullness at the end of the incision) you will need revision surgery.Most likely your incision will need to be extended in combination with Liposuction.
It’s possible that the contour can be improved with liposuction alone or just skin excision.
Ideally the extent of the tummy tuck should’ve been predicted and described before surgery during an in person consultation. An experienced and talented surgeon should not be leaving dog ears. A good surgeon will assess the patient accurately and know when an extended tummy tuck is indicated.
The outcome of your procedure probably represents a standard or average outcome by average surgical skills in the United States.
Ending up with dog ears is not at all uncommon so there is no evidence of inappropriate surgery or gross lack of competence. top-notch plastic surgeons typically don’t leave dog ears.
An extended tummy tuck also requires turning the patient during surgery and typically the backside is treated first then the patient is again turn onto their back at which time the main tummy tuck is completed on the front of the abdomen.
An extended tummy tuck can be called a partial wraparound, partial body lift, semi circumferential tummy tuck etc etc. The concept being that individuals who have skin laxity that continues beyond just the front of their abdomen will need a skin excision that goes beyond the hips.
I’m not a fan of virtual consultations regardless how thorough both patient and surgeon attempts at being.
There’s simply no substitute for an in person consultation in order to get an accurate assessment and for the patient to properly vet the provider.
My recommended way of choosing a plastic surgeon for a tummy tuck is the first schedule multiple in person consultations staying local whenever possible.
During each consultation ask each provider to open up the portfolio and show you their entire collection of before and after pictures.
Surges may be apprehensive to do that but patients should be persistent they want to see as many pictures as possible especially of patients who have similar body characteristics to your own.
Ask the surgeon to show examples of excellent outcomes, average outcomes and less than outcomes.
Ask specifically about the surgeons revision rate and what your policies are regarding revision surgery.
Ask each surgeon to show you examples of patients who needed revisions and what they look like before and after.
Surgeons make it slightly annoyed at patients telling them what to do but you need to be in the driver seat since you’re the one paying for the procedure and will end up with the results. patients should take vetting of plastic surgeons seriously. You are in the end responsible for the choice of surgeon which has an immense impact on the potential outcome.
There are major differences in outcomes among different providers in the field of plastic surgery.Simply being board-certified and plastic surgery with an overall good reputation is insufficient to confirm someone has mastered anyone a procedure. When reviewing pictures bring with you pictures of your own torso so with the views from all side so you can compare and find other patients who have similar characteristics.
When reviewing results look very carefully at who gets the most natural looking belly buttons on a consistent basis as well as a very low set scar preferably with a slightly convex incision over the mons pubis with the scar following anatomic contours naturally and evenly on both sides. ideally the scar should be set in the groin crease. make sure the torso looks balanced proportionate and attractive from all angles including from behind.
This is the time to discuss indications for modifications of the procedure such as the need for an extended tummy tuck or additional liposuction.
Patient should have a clear understanding if the surgeon is planning on turning them in the operating room or doing all of the surgery with the patients laying on their back.
Patients need to have a clear understanding that without turning their body during surgery the surgeon is inherently limited in what they can accomplish when it comes to the extent of surgery and doing quality liposuction.
An experienced surgeon should have no difficulty showing you at least 50 sets of before and after pictures. Highly experienced surgeons will have hundreds or even thousands of before and after pictures of commonly performed procedures like a full tummy tuck.
Finally I recommend patients read all reviews on various physician review websites avoiding providers with any significant number of justified negative reviews.The absence of justified negative reviews is more important and more telling than having an abundance of positive reviews.
Patients should be familiar with what before and after pictures look like and what a quality tummy tuck results should look like before the consultation.
This includes all the above stated variables such as a natural looking belly button, Lois that scar, Esquire that follows anatomic contours naturally and his even on both sides with a Torso looking balanced and proportion it from all angles.
Devise a rating scale and score 8 surgeons results based on your own ratings and make notes of why or why not you like the outcomes of each provider you consult with.
When in doubt slow down and schedule more consultations.
A full tummy tuck as a permanent and more or less irreversible procedure. Certain things can definitely be improved upon and in your case your outcome will need a revision to be at its best and there are no inherent limitations based on what was done.
In other instances if the belly button doesn’t come out looking good it’s often very difficult to improve once the procedure is performed.
Patients to travel for surgery should expect to travel for their follow up. Your surgeon needs to address the fullness on your lower abdomen and confirm it’s not a fluid collection.
If it is it will need to be treated surgically.
Your surgeon is responsible for your outcome and you are responsible for choosing that surgeon.
It’s highly unlikely some thing ruptured or any particular thing went wrong but the phone is either A direct reflection of how the procedure was performed or could represent a fluid collection called a seroma.
I recommend you have an in person follow up with your surgeon at which time you can review all of your concerns and talk about revision surgery.
Ideally all plastic surgeons should talk about the revision policy during consultations for any surgical procedure so patients are well informed.
Most surgeons do not charge for revision surgery but it’s often asked the patients pay for facilities such as operating rooms and anesthesia fees if needed for revision surgery.Some plastic surgeons will do revision work included more extensive revision work as an office based procedure while others will do it in a formal operating room.
Each surgeon has their own way of practicing medicine and decides how best to care for their patients and run their practice.
At seven months your results are final with the exception of how your scar looks. there’s probably very little swelling at this point and the contour of your body will not change by waiting further. The scar and how it appears will continue for to change and most likely improve for an additional year. Skin incisions can take 18 months before they are mature.
Best,
Mats Hagstrom MD