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

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!

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

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.

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.

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.

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!

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.

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.

To make an accurate assessment regarding the outcome of any plastic surgery procedure we generally need to see a complete set of proper before and after pictures.
If you don’t have before, and after pictures and ask your surgeon to forward, the pictures they took.
Without seeing before pictures, we can’t assess your candidacy for the procedure in the first place.
There are four tissue variable to determine what the abdomen looks like.
This is true whether someone has had surgery or not.
The four tissue variables that determine what the abdomen looks like are the following.
1) abdominal skin laxity typically due to previous pregnancies or weight loss.
2) excess subcutaneous fat.
3) muscle separation from previous pregnancy.
4) excess visceral or subcutaneous fat.
Muscle tightening rarely fails.
Simply going through the above for tissue variables should be able to decipher the problem.
Skin laxity, and muscle separation treated by your tummy tuck.
you don’t have thick layers of subcutaneous fat, so that variable is not contributing in a substantial way.
This leaves excess visceral fat as the culprit and most likely cost for your bulging abdomen.
In fact the bulging abdomen after a tummy tuck is almost always due to access, visceral fat.
This is often associated with individual source still obese, but there are those individuals who have a fat distribution that causes excess digital fat without being significantly overweight.
Excess visceral, fat and muscle separation before tummy tuck have a fairly similar physical appearance.
The abdominal wall bulges.
Differentiating between visible, fat and muscle separation isn’t rocket science and is fairly straightforward.
Most plastic surgeons should be able to distinguish between the two fairly easily, and in a fairly straightforward manner.
Way is to see what your abdomen looks like when you lay on your back.
If the abdomen goes completely flat and has a slightly caved in appearance, while laying on your back, the muscle separation is more likely. The problem and visceral fat is not.
If the abdomen is still slightly extended while laying on the back , then visceral fat is more likely the problem.
Another way it’s a differentiate between the two is take your non-dominant hand and press your abdomen until the abdominal wall is flat.
For reference a flat abdominal wall should create a B line between your sternum and your pubic bone.
If it takes a significant amount of pressure to press your abdomen flat with your non-dominant hand, then visceral fat, is most likely the culprit creating back pressure against your abdominal wall, or an increased in abdominal pressure while pressing your abdomen flat. if while pressing your abdomen flat, it feels like your abdomen is excessively full and is difficult to take a deep breath. Then visceral fat is most likely the culprit.
Including your before, pictures would help us make an assessment regarding your candidacy for the procedure.
While muscle separation and visceral fat, can have a similar appearance, there is usually a fairly typical look to those who have access visceral fat.
Individual who have access visceral fat should be explained that this is going to inherently limit the potential outcome of a tummy tuck unless the individual loose is fat before the procedure.
How much fat do you need to lose? Enough fat That your abdomen goes completely flat when you lay on your back or you can press your abdomen flat with your non-dominant hand without having to push very hard.
Weight loss will most likely get you a flat abdomen.
How much weight loss do you need? Try losing 5 pounds and then take Another set of pictures and check yourself.
Lose 10 pounds and you should see a significant improvement.
I recognize that you are not obese in your appearance, but as I mentioned earlier, some individuals have a fat distribution that leans heavily towards having excess visceral fat.
These individuals often have a history of having some abdominal bulging even before their first pregnancy.
Visceral fat response quite drastically to weight loss.
While excess visceral fat is somewhat more prevalent in men there are plenty of women who have this fat distribution as well.
Making a quality assessment before plastic surgery leads to predictable outcomes.
Patient candidacy, and provider selection are the two single most important variables for quality plastic surgery outcomes.
I don’t think your procedure was done badly but perhaps your surgeon could’ve done a slightly better job in making a preoperative assessment.
To get an accurate assessment you need an in person second opinion consultation, including an examination.
I could be wrong, but excess visceral fat is almost always the culprit when patients complain of a bulging abdomen after a full tummy tuck.
Best,
Mats Hagstrom, MD