I Don't Have The Flat Stomach I Expected After Tummy Tuck

I had a full TT 5 months ago I was 5'4 and weighed 123lbs. I workout and have a low-cal diet, I never had a fat stomach just separation of muscles and loose skin. I expected to look completely flat after my full TT with slight liposuction but its not, I still have a slight pouch. I told my PS and he said everyone will still have a slight pouch or they are sucking in. I am back working out but the change is not like I expected. No one can tell I had anything done and I am 120 lbs is this true?

Doctor Answers 4

No flat stomach after tummy tuck!

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You certainly sound fit and non-obese, but your surgeon still had the same volume and weight of intra-abdominal contents to "contain" within your tightened abdominal wall after removal of excess skin and fat. No matter now tightly your surgeon sews the rectus muscle sheaths together, your "insides" (intra-abdominal organs, intestines, mesenteric fat, and omental fat) still had their exact same size, weight, and volume "pushing out" against a tightened, but not rigid and unyielding, abdominal wall and skin. That's just anatomy, and this has nothing to do with your surgeon's skill (or lack thereof), or the technique used. (Unless, of course, he "skipped" the muscle repair.) It's the natural stretchiness of your (even surgically-tightened) abdominal wall combined with your own intra-abdominal contents.

An example might be helpful. Think of your loose stretched (pre-op) abdominal wall as a trampoline (one that is a bit older and well-used; i.e., a bit stretched out). Now put some pressure on that trampoline, like a bowling ball tossed onto its center and being pulled by gravity. No matter how tight you screw the turnbuckles on that trampoline, the bowling ball will still stretch the fabric somewhat, even if you somehow also tightened the fabric by removing some of it. An imperfect example, I know, but one that illustrates that your "insides" still push outward, no matter how tight your abdomen has been made. True, some patients do achieve flat, but usually only if they were flat before surgery (just loose skin and stretched muscles).

If the amount of skin and fat removed was 3 pounds, this would be a good amount for a woman your size. Sorry to be the bearer of bad news, but it sounds as if the only problem here was unrealistic expectations. Unfortunately, sometimes we surgeons are the cause of these expectations if all we show are the "perfect" results with the "flat" after photographs.

Yours is the more common result. Talk to your surgeon, but there is likely nothing further that can be done except to lose 10 pounds or so--and this may still not even give you the "flat" tummy you seek. Best wishes! Dr. Tholen

Minneapolis Plastic Surgeon
4.9 out of 5 stars 263 reviews

Stomach not flat after TT

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I'd appreciate it if you would post photographs. If there is a pouch, like a bulge, you might need a small revision but please know that women are not built "flat as a board" and that you shouldn't have the expectation of an abdomen with absolutely no contour.

Pouch after tummy tuck

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Without pictures it is very difficult to give you advice other than just general comments. I have found with my patients that sometimes the scar pulls in and makes it appear that there is more of a pouch than there really is. Scars will often soften and stretch out with time and massage. Hope this helps.

Margaret Skiles, MD (retired)
Sacramento Plastic Surgeon

Tummy Tuck Results not what I Expected?

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Thank you for the question.

It is difficult to give you advice without examining you and/or  viewing pictures. Direct examination will be necessary to determine if revision of your tummy talk will allow you to achieve the results that you are looking for. On the other hand, physical examination may demonstrate an excellent result and a potential problem with communication and/or realistic expectations prior to surgery.

I would suggest that you continue to follow-up with your plastic surgeon to communicate your questions and concerns.  if you feel that there is a “failure to communicate”, seek an additional consultation in-person with a well expensed board-certified plastic surgeon.

Best wishes.


These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.