8 months post-op - Why my upper ab bigger after tummy tuck and muscle repair? (Photos)

Question

I'm 5’4 and 160 lbs. Why my upper ab bigger after tummy tuck and repair? I’m 8 months post op.

Dhaval M. Patel, MD · Answer

Thank you for your questions and photos. Talking to your surgeon about your concerns is always the best place to start. From your photo, it appears the muscle repair was not completed from the bottom of your rib cage to your pubic bone. That being said, a proper exam would be needed to have a better idea. The abdominal wall can be weakened after pregnancy and (or) significant weight gain & loss. By repairing the muscle during a tummy tuck, not only does the appearance of your abdominal area improve, but your core strength as well. The repair of the muscle will cinch your waist like an inner corset, which will accentuate your curves. Liposuction will remove excess fat from unwanted areas with some skin retraction. Your expectations and health will dictate the best procedure(s) for you. I suggest a consultation with a board certified plastic surgeon to go over the options that best address your goals. Best of luck!

Dhaval Patel MD
Double Board Certified Plastic Surgeon
Chicago
South Barrington
Oakbrook
Orland Park

Dhaval Patel MD 
Double Board Certified Plastic Surgeon
Chicago 
South Barrington 
Oakbrook
Orland Park

Alan Gonzalez, MD, FACS · Answer

Hello @Graceful867234, thank you for your question. It is critical to consult the doctor that performed the surgical procedure. This is because he knows what type of technique he or she used and how he or she performed the procedure. Ask if a lower or total muscle tie was performed, and you will be able to clarify your doubt. For more information and recommendations, it is best to consult with one or several board certified plastic surgeons. Best wishes! Alan Gonzalez MD, FACS.

Daniel Barrett, MD · Answer

Dear Graceful867234,
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

Camille Cash, MD · Answer

Thank you for your photos and question.  The appearance of your upper abdomen is either due to the muscle wall not being repaired, the repair failing, or from visceral fat.  If it is from visceral/internal fat then weight loss should improve it.  I encourage you to discuss your concerns with your surgeon.

Connie Hiers, MD, FACS · Answer

Just based on your one preop photo, your upper abdomen is smaller after surgery. You may have some internal fullness which cannot be treated with a tummy tuck. Ask your surgeon if your upper muscles were tightened as well.

Mats Hagstrom, MD (license on probation) · Answer

To make an assessment on the outcome of an operation we always need to see proper before and after pictures. If you don’t have before and after pictures then contact your provider and ask them to forward the pictures they took.
There are two primary reasons someone’s upper abdomen will bulge after a full tummy tuck.
The first is individuals who are barrel chested. if the sternum sits significantly in front of the pubic bone the muscle tightening creates an oblique slope of the abdominal wall. Muscle tightening is more effective on the lower abdomen and the projecting rib cage pushes out the upper abdominal contour.
This type of body proportion can usually be seen in before pictures and the outcome is somewhat predictable for providers with sufficient skill and experience. For Individuals who have this type of body contour consideration should be given to less muscle tightening of the lower abdomen.
The second variable that can cause a problem of upper abdominal bulging after the procedure is excess visceral fat. This can also be diagnosed before surgery and is predictable. Patients with excess intra-abdominal or visceral fat need to lose weight in order to not have a bulging upper abdomen. even with muscle tightening the increased intra-abdominal volume from excess visceral fat needs to go somewhere and because the lower abdomen is affected to a greater extent by muscle tightening the upper abdomen will instead bulge.
Excess visceral fat can only be lost through weight loss and individuals whose abdomen is bulging because of visceral fat get significant improvement from the outcome of the procedure from weight loss.
Your pictures show a slight difference of the upper and lower abdomen subcutaneous fat layer and I wonder if you are provider did Liposuction in conjunction with the procedure and if this may have been done excessively on the lower abdomen? it’s not a primary cause for your bulging upper abdomen but may be adding slightly to it? 
Follow up with your provider and if seeking second opinions always bring before and after pictures and ideally a copy of the operative report.
Best,
Mats Hagstrom MD

Arian Mowlavi, MD, FACS (license on probation) · Answer

Based on your photos, the issue is a very common deformity after not a well-done TT. It is the result of the inadequate tightening of the upper abdomen compared to the lower abdomen. In fact, to look nice and aesthetically pleasing, it should be reversed. if any area is to be tightened less, it is the lower abdomen. To fix the problem you need a re-do TT.You would likely benefit from a high definition tummy tuck using high definition VASER liposuction. The tummy tuck procedure would comprehensively remove excess skin and fat in the abdominal region. The abdominal muscle would also be 'tightened' to create the appearance of a flatter stomach. A Skype or FaceTime consultation with a tummy tuck specialist will help you get an accurate recommendation and pricing.

Respectfully,
Arian Mowlavi MD, FACS
Realself 100 Hall of Fame Inductee

Respectfully, 
Arian Mowlavi MD, FACS
Realself 100 Hall of Fame Inductee

George Lefkovits, MD - Account Suspended · Answer

There can be many reasons for a post-op upper abdominal bulge after a TT. It would be helpful to see the pre-op photos. But it could be due to Fat above the muscle in which case liposuction is the treatment. It could be due to Fat below the  abdominal muscle  which is not amenablwe to surgery. It may be due to insufficient approximation or recurrent sepration  of the abdominal muscles. You would best served by returning to your surgeon. good luck!

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