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.

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....

Mats Hagstrom, MD (license on probation) · Answer

To assess the outcome of a plastic surgery operation we always need to see before and after pictures.
Without knowing what you look like before surgery severely hampers our ability to make an accurate assessment.
My best guess is that you had significant skin laxity beyond where your incisions end. The ideal procedure would’ve probably been an extended or wraparound tummy tuck. limiting the length of the scar increased the chances of you developing dog ears(an actual plastic surgery medical term). One way to minimize dog ear formation when the length of the scar is limited is to advance the upper skin flap towards the midline. Recognized that people with skin laxity have loose skin in a both vertical and horizontal direction. A regular tummy tuck only treats skin laxity in a vertical direction. The horizontal the skin laxity needs to be managed and will create a dog ear unless the skin excision is taking around to the backside through an extended or wraparound tummy tuck.
By advancing the abdominal skin towards the midline the surgeon is able to minimize doggy information but causes a possible accumulation of skin laxity towards the midline.
I believe the contour on the front of your abdomen is related to horizontal skin laxity not treated by the procedure. redoing the operation and converting it to an extended or wraparound tummy tuck or converting it to a fleur-de-lis pattern with a full vertical incision are two alternatives to improving the outcome. while redoing the procedure is quite extensive it does not need to incorporate muscle tightening. it would most likely still require placement of drains but without reproducing the muscle tightening part of the procedure physical recovery would be far easier than the primary procedure.
Other potential explanations for the contour is a possible fluid collection or inherent shape of the abdominal wall as a result of surgery or baseline.
I believe skin laxity is the cause and some of it is a direct reflection of how the procedure was performed.
Individuals with excessive skin laxity can get slightly compromised outcomes if the procedure is not done as an extended operation or a vertical scar is added.
I think your surgeon try to accomplish as much as possible without extending the amount of surgery but it’s possible that a better outcome could’ve been achieved with a more extensive operation.
There are advantages and disadvantages to each approach and your surgeon must likely used good judgment in deciding what was in your best interest.
Sometimes it can be hard to predict how much horizontal skin laxity can contribute to the final outcome.
Adding an unnecessary full vertical midline incision is undesirable unless absolutely necessary.
For some people it is the correct approach in order to eliminate both vertical and horizontal skin laxity.
Without seeing before pictures we can’t make an assessment of what would’ve been a better procedure.
If you don’t have proper before and after pictures and ask your surgeon to forward the ones they took.
Follow up with your provider and see what he or she has the same. To get a proper second opinion consultation scheduled those is inpatient consultations with other local board-certified plastic surgeons. For a second opinion consultations patients should come prepared to bringing with them proper before and after pictures and a copy of your operative report. These are all part of your medical records and available to you upon request from your current provider.
Best,
Mats Hagstrom MD

Jose A. Munoz, MD - Account Suspended · 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...

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

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