Bulge at top and bottom of abdomen 7 months post tummy tuck. What can this be and what are my options? (photos)

Question

Hello, tummy tuck done 7 months ago. Bulge at top, and bottom. Can you please tell me your thoughts based on pictures.

Jose A. Munoz, MD · Answer

Hi and welcome to our forum!From your photos, I note 2 areas of localized fullness at anterior midline above the umbilicus and slightly to the left of midline below the umbilicus. There is also flank fullness. Fluid (seroma, organized hematoma), chronically infected plication sutures, fat necrosis, or localized fat accumulations are all possibilities. As you appear to demonstrate full flanks as well, the presence of residual accumulations of fatty tissue is a likely cause of the lower abdominal fullness. I can't determine the nature of the superior fullness from a photograph alone. A physical examination would be helpful. Revisit your plastic surgeon for evaluation and advice.Best wishes...

Semih Yildiz, MD, FEBOPRAS · Answer

The photos show persistent upper abdominal fullness and a lower abdominal fold/overhang near the scar, but an in-person exam is needed to tell whether this is residual fat, loose skin, scar tethering, swelling, or laxity of the muscle repair. At 7 months, some scar maturation can still occur, but a significant contour bulge usually deserves a direct follow-up exam rather than just waiting blindly.

The treatment depends on the cause. Residual fat may improve with targeted liposuction, loose lower skin may need scar/lower abdominal skin revision, and true muscle laxity or recurrent diastasis would require evaluating the muscle repair rather than treating only the surface. I would start with your operating surgeon, review pre-op photos and the operative plan, and consider revision closer to 9-12 months once the tissues are softer and your weight is stable.

Alan Gonzalez, MD, FACS · Answer

Hello @Gorgeous8005, thank you for your question and showing you pictures. I understand your concern. It is important to take into account several aspects among which is the surgical technique applied, and to evaluate if there is something else at a systemic level. The best course of action is to consult one or several board certified plastic surgeon for more information and options tailored specifically to your needs. Best wishes! Alan Gonzalez MD, FACS. International Federation for Adipose Therapeutics and Science” Member (IFATS), American Society of Plastic Surgery Member (ASPS), Colombian Society of Plastic Surgery member (SCCP)

Nelson Castillo, MD · Answer

Thank you for sharing your question and photographs.  Unfortunately there are significant contour issues in your abdomen that will require surgery to correct.  The nature of the bulges could be from irregular muscle repair, hernia, fluid collections or poor skin redraping.  I would advocate seeking out second opinions from board certified plastic surgeons to get the best advice.

Daniel Barrett, MD · Answer

Dear avery2002,
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

Connie Hiers, MD, FACS · Answer

I would suggest getting an ultrasound to see if fluid is present. Then, if negative, let your surgeon examined you. Perhaps the upper muscle was not tightened and now protruding. An examination is needed to see what is going on with the lower part. You may have some residual fat in both areas which could be treated with liposuction.  Please discuss your concerns with your surgeon.

Mark Eberbach, MD · Answer

First ask your surgeon for help.

This can be caused by two things I know of. First if not there on day one think seroma. 
If it was there from the beginning, inadequate lateral undermining can cause it.

Consider an ultrasound of the area to investigate further.

Cassie Nghiem, MD · Answer

It's hard to give a definitive answer without examining you. But generally speaking, the upper bulge can be caused by lack of adequate rectus diastasis repair (muscle tightening), or lack or inadequate liposuction in the upper abdomen. I understand the tendency is liposuction less in that area at the same time of the tummy tuck because it can compromise the blood supply. However, both those issues appear fixable. Hope that helps!

Camille Cash, MD · Answer

The contour irregularities that are shown in your photos are not typical.  It would be helpful to see your before photos to help determine what may have occurred.  I encourage you to return to your surgeon to discuss your concerns as well as interventions to improve the results.

Darryl J. Blinski, MD · Answer

Nicely posted photos. Appears something went wrong? Best to obtain an ultrasound or MRI of the abdomen ASAP. Then with the dx from these examinations a surgical revision plan can be determined. I suspect full revision of the TT and muscle plication is needed. Fees from $10,000+. Best to virtual consult with....

Bulge at top and bottom of abdomen 7 months post tummy tuck. What can this be and what are my options? (photos)

Answers (11)

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