Is this a failed muscle repair or swelling? What do I need to do to fix this? (Photo)

Question

Had my original surgery 10/29/23, was swollen but flat initially. Currently look like in the pictures. Is this a failed Mr or swelling? Do I need more lipo? I'm going in for a revision on Friday and my doctor believes I only need some mr tightening and fixing dog ears and minor revision to belly button. Will MT tightening resolve the bulge or do I also need to ask for lipo?

Ajaya Kashyap, MD · Answer

Thankyou for your query. It is difficult to say if there is adequate muscle repair or not from photographs alone. Your surgeon can check both the repair and also the presence of any superficial fat in your abdomen. If there is intra-abdominal fat, it can not be removed with liposuction. Your surgeon can check that out. Please get a second opinion, if in doubt. All the best!

Sanjay Parashar, MD · Answer

From photos alone, it is not possible to say that the muscle repair has failed.
An abdominal bulge after a tummy tuck can come from a few different things. Your surgeon should check whether there is visceral fat inside the abdomen, as this can push the abdominal wall outward and cannot be treated with liposuction.
Another factor is muscle tone. Even if the rectus muscle repair is intact, a thin or weak abdominal muscle can still bulge forward. In that situation, reducing visceral fat and improving core muscle tone can help.
Your surgeon should also assess whether you still have subcutaneous fat under the skin, which may be improved with liposuction, or whether there is recurrent muscle separation (diastasis) that may need to be repaired again.
So the key is to determine whether the bulge is mainly coming from visceral fat, weak muscle tone, residual subcutaneous fat, or recurrent muscle separation before deciding whether you need liposuction or another muscle repair.

Semih Yildiz, MD, FEBOPRAS · Answer

The photos show a lower abdominal bulge with some residual skin and soft-tissue fullness, but photos alone cannot separate a loose or failed muscle repair from subcutaneous fat, visceral/intra-abdominal fullness, skin laxity, scar tightness, or a fluid collection. At more than a year after surgery, persistent fullness is less likely to be simple swelling, although swelling can still vary from day to day.

Muscle repair tightening helps most when the main problem is a central abdominal wall weakness or diastasis. Liposuction helps only with pinchable fat above the muscle; it will not correct a loose muscle repair, internal fat, or loose skin, and aggressive lipo under a tummy tuck flap can add risk. Since your revision is soon, ask your surgeon to examine you standing and lying down, check the muscle repair, pinch the fat layer, and decide in advance whether lipo is truly needed or whether tightening, dog-ear correction, and belly button revision are enough.

Leila Kasrai, MD, FRCSC · Answer

Without an in-person assessment, it would be difficult to say whether this is caused by excess fat, failed muscle repair or something else. You did mention that you were flat initially, so it might not be excess fat. Please trust your surgeon as they’re more knowledgeable of the specifics of your situation.

J. Timothy Katzen, MD, FACS · Answer

Hello, and thank you for your question regarding whether your abdominal bulge is due to a failed muscle repair or residual swelling after your tummy tuck. Based on your history and the provided timeline, it is difficult to determine the exact cause without a thorough in-person examination, comparison to pre-surgery images, or imaging such as an MRI. However, I can provide some insight into possible causes and solutions.

In many cases, a persistent bulge months after a tummy tuck may indicate a compromised or incomplete muscle repair rather than simple swelling. If your plastic surgeon has recommended additional muscle tightening during your revision, this suggests they suspect the muscle repair may not have been as secure or strong as needed initially. If the abdominal bulge is due to intra-abdominal pressure from an enlarged peritoneal cavity—located behind the rectus abdominis muscle—then simply tightening the muscle may help but may not fully resolve the issue. In such cases, many experienced board-certified plastic surgeons would recommend reinforcing the repair with surgical mesh. This mesh can provide additional support to keep the abdominal wall flat and prevent further bulging over time.

As for liposuction, it is unlikely that additional lipo alone would resolve the issue if muscle separation is the underlying problem. Liposuction primarily targets excess fat, not muscle laxity or intra-abdominal pressure. If there are areas of fat that were not fully addressed in your initial procedure, lipo may provide some additional contouring, but it will not correct a weakened abdominal wall.

For the best long-term results, a combination of muscle repair and, in some cases, mesh reinforcement may be ideal. If you have concerns, it is worth discussing all of these options with your surgeon before your revision surgery.

Thank you for your question regarding whether you have a failed muscle repair or swelling and what can be done to correct it. If you have further concerns, consult an experienced, board-certified plastic surgeon with extensive experience in tummy tuck revisions.

Sincerely,
Dr. Katzen

Arif Eroglu, MD · Answer

Hello; if you think for that; there is looseness in the abdominal muscles; please lay down on the ground; try to sit up without any support. Meanwhile, tap into your abdominal muscles. If relevant muscles are loosing; during straightening position, muscles will come too far forward. However, having an internal fat before surgery or excessive gas in intestines after surgery; may cause for this type of image. If lipoabdominoplasty was not performed; that is, if fat was not removed from the abdomen by Liposuction during the Tummy Tuck process; fat erase may be helpful at that time.

Ira H. Rex III, MD · Answer

It is not possible to determine if liposuction will help in your situation.  Only an examination would allow me to give you good advice.  Good luck with your revision.

Jeremy Bosworth, MD · Answer

Difficult to tell purely from pictures but if you haven't gained a significant amount of weight after surgery and you were flat at one point it could just be the muscle needing some more tightening. Physical exam is the best way to determine if there is any extra fat there which Im sure your surgeon will do and its always ok to ask if you think you need it. I think the dog ear/ skin excision will help out nicely too!

Connie Hiers, MD, FACS · Answer

An examination is needed to be certain, but your fullness appears to be more internal than external, and surgery will not correct this. This swelling is often improved by changing your diet. Many with prominent abdomens and normal weight have food allergy issues and keep their colon swollen.  You might want to discuss this with your medical doctor and get tested for food allergies.

Camille Cash, MD · Answer

The contour that concerns you is likely either from muscle repair failure or from visceral fat.  If it is muscle repair failure then a revision will correct the problem.  If it is visceral fat then only weight loss will improve it.  Visceral fat is the internal fat behind the muscle wall that can't be improved with liposuction or a tummy tuck.  Your surgeon will be able to help determine the cause with an evaluation.

Is this a failed muscle repair or swelling? What do I need to do to fix this? (Photo)

Answers (11)

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