Extra skin left and possible failed muscle repair (Photo)

Question

I had a Mommy makeover done back in the end of May which included a breast lift full tummy tuck with muscle repair. I’m wondering if not enough skin was removed during my procedure, because I still seem to have pooling skin near the incision line when I stand and especially when I sit. The skin is very thin in this area and seems as though it should’ve been removed. I also have a bulge up above my bellybutton area that is firm and gets worse as the day progresses. Thoughts?

Gerald Minniti, MD, FACS · Answer

Although this was an error in judgment by the surgeon, you can be assured that erring on the side of too much skin left is far better than too much skin taken. Although it will be an inconvenience and added expense, a full revision tummy tuck is necessary; it's not just residual excess at the scar, it's excess above the belly button. This will also give you the opportunity to lower the scar at all points along its line, making it less conspicuous.  Additionally, the muscle repair can be assessed and revised.

Connie Hiers, MD, FACS · Answer

The upper bulge probably could be treated with liposuction. Liposuction in that area at the same time of the tuck is usually not safe and is not done. Your lower side bulge can be excised or perhaps treated with liposuction. Please discuss your concerns with your surgeon.

Camille Cash, MD · Answer

Some redundant skin is expected when in a seated position, but it does appear from your standing photos there is some that could still be removed during a revision.   An evaluation is needed by your surgeon to determine if the upper portion of the muscle repair has failed.  If so that can also be addressed during a full revision.

Mats Hagstrom, MD (license on probation) · Answer

We typically don’t make assessments with the hips flexed. All people will have skin redundancy in a sitting position. If the skin were to be tight in a sitting position, you wouldn’t be able to stand up. This is true for all people whether they’ve had surgery or not. Individuals who have substantial skin laxity that carries over on the sides or backside should be considered for an extended tummy tuck. There’s a limit to how much skin can be removed without repositioning the patient during surgery. This is probably the number one reason that patients still have skin redundancy on the lateral aspects of their incision. 
I suggest you follow up with your provider and discuss your concerns with him or her. Excising skin around the dog ears after a tummy tuck is probably one of the most common revision procedures in plastic surgery.
When selecting plastic surgeons and vetting providers, I suggest patients review before, and after pictures critically, paying close attention to the following characteristics, which tend to be hallmarks of quality tummy tuck surgery. The first is a natural looking bellybutton. The second is a very low set scar that follows at atomic contours, naturally and evenly on both sides and the third is looking at the torso, making sure the hips look attractive, natural and balanced from all angles, including from behind. 
Plastic surgery outcomes are usually based on two variables. The first is the patients candidacy for the procedure, and the second is the skill and experience of the provider. There isn’t all that much patients can do regarding their own candidacy with the exception of losing weight if they are obese. What patients do you have control over is provider selection.
I generally recommend patients have multiple in person, consultations before selecting a plastic surgeon. During each consultation, ask each provider to open up their portfolio and show you their entire collection of before, and after pictures of previous patients, who had similar body characteristics to your own. An experience plastic surgeon should have no difficulties showing you the before and after pictures of at least 50 previous patients. Being shown a handful of pre-selected images, representing only the best results of a providers career is insufficient to get a clear understanding of what results look like in the hands of each provider, what your results are likely to look like or how many of these procedures they’ve actually performed.the biggest mistake patients make is having only one consultation and then scheduling surgery. 
Being board-certified in plastic surgery does not mean somebody has mastered every procedure.
I suggest you follow up with your provider and discuss your concerns with him or her. You can also consider scheduling in person second opinion consultations. For in person, second opinion consultations, I suggest coming prepared with a complete set of proper before and after pictures and a copy of your operative report. These are all available from your current providers office if you request them.
Best,
Mats Hagstrom, MD.

Extra skin left and possible failed muscle repair (Photo)

Answers (4)

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