Lower abdomen bulge 16 months post tummy tuck - what could this be and what are my options to correct this? (photos)

Question

Age 56, healthy female, 16 months post-up tummy tuck procedure. Experiencing pouching below belly button that was not there prior. It is firm and not squishy like fat. Trying to determine the underlying cause to have it addressed. Surgeon said it is fat. Recd 48 injections mesotherapy which did very little. Can't find a doctor that will weigh in to provide a clue as to what has caused this or recommend how to solve it. I look worse than before.....

Alan Gonzalez, MD, FACS · Answer

Hello @ldmarsh777, thank you for your question. In terms of surgery, there are many factors to consider: the technique used is one of the most important factors, but it may also be worth considering any underlying systemic issues. I would encourage you to schedule a consultation with a board-certified plastic surgeon. During your consultation, your surgeon will be able to assess your unique needs and develop a treatment plan that is right for you. Best wishes! Alan Gonzalez MD, FACS. American Society of Plastic Surgery Member (ASPS),  International Federation for Adipose Therapeutics and Science”  Member (IFATS), Colombian Society of Plastic Surgery member (SCCP).

Randal Haworth, MD, FACS · Answer

I'm sorry to hear that you're experiencing discomfort and frustration after your tummy tuck procedure. Without examining you, it's difficult to provide a definitive answer to what might be causing the pouching you're experiencing, but there are a few possibilities that could be worth exploring.

One potential cause of the pouching could be a fluid buildup known as a seroma. This is a common complication of tummy tuck surgery, and it occurs when fluid collects in the space between the skin and the abdominal muscles. Seromas can be firm and not squishy like fat, as you describe. If this is the case, your surgeon may need to drain the fluid or take other measures to address the problem.

Another possible cause of the pouching could be a hernia. A hernia occurs when an organ or tissue pushes through a weak spot in the abdominal muscles. This can cause a bulge or pouching in the affected area. If this is the case, you may need to see a specialist such as a general surgeon to determine if surgery is necessary to repair the hernia.

It's also possible that the pouching is due to residual fat that wasn't removed during your tummy tuck procedure. If this is the case, your surgeon may need to perform additional liposuction to remove the excess fat.

Given that your previous surgeon has dismissed your concerns, it may be worth seeking out a second opinion from another board-certified plastic surgeon or a general surgeon. A thorough evaluation including a physical exam and possibly imaging tests such as an ultrasound or MRI may be needed to determine the underlying cause of the pouching and the most appropriate treatment.

It's important to remember that every surgical procedure has potential risks and complications, and it's not uncommon for patients to experience unexpected outcomes. However, you deserve to have your concerns heard and addressed, and it may be necessary to seek out another provider who is willing to work with you to find a solution that meets your needs.

I hope this helps,
best of luck !

Daniel Barrett, MD · Answer

Dear ldmarsh777,
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, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Carlos Marciales, MD · Answer

Probably you will need more tight repair of the muscles in the lower belly, it can be fix. Talk to your doctor

Heather Vande Ven, DO · Answer

A bulge in the lower abdomen in 16 months after a tummy tuck could be due to various factors such as residual fat, muscle weakness, or even fluid accumulation. It’s essential to consult with a board-certified plastic surgeon or your healthcare provider for a proper evaluation. They can determine the cause and discuss potential corrective options, which might include revision surgery, liposuction, or other non-surgical treatments depending on the underlying issue.

Connie Hiers, MD, FACS · Answer

If it is fat, liposuction can be done to reduce it. Liposuction was not done in that area at the time of your tuck for safety to the sign. The other possibility is that this is some fibrosis from a previous seroma or fluid collection.  I would suggest discussing this with your surgeon.

Camille Cash, MD · Answer

There are several potential reasons for the change in your abdominal contour.  It could be visceral fat (internal fat) if you have gained weight.  It could be underlying GI issues.  If it is subcutneous fat it should be improved by liposuction.  There's also a chance the muscle repair could have failed.

Darryl J. Blinski, MD · Answer

Nice series posted photos. I recommend in office sub q ultrasound to see if there is a layer/s of fat or split muscles or both? ( fee $500 in office done by me). If fat can offer directed superficial liposuction under ultrasound guided removal - $5,000. If split muscle wit or w/o fat only re opening inferior TT scar with dissection re repair muscle and lipo of skin fat flap with layered suture and 1 or 2 drains. Fee $6,000. Best to virtual consult with....

Mats Hagstrom, MD (license on probation) · Answer

Based on your pictures, your subcutaneous fat layer is quite thin. The contour most likely is a direct reflection of the shape of your abdominal wall. This was modified from the tummy tuck with muscle tightening or at least, I’m assuming you had muscle tightening as part of the procedure. You may have slight excess visceral fat does causing some pressure against your abdominal wall. if muscle tightening was done aggressively around your upper and mid abdomen, then that slight bit of excess visceral fat would cause bulging in whatever part of the abdomen is weakest or allows for bulging.
There are four variables that determine what the abdomen looks like. Generally, any issues related to abdominal contour, can be explained by one or more of these four variables. The four variables to determine what the abdomen looks like our skin laxity, excess subcutaneous fat, muscle, separation, or excess visceral fat. Most likely the contour it’s a direct reflection of a combination of those for variables. My best guess is that the bulge represents how muscle tightening it was done in combination with slight excess of visceral fat, which may be prohibiting your abdomen from being completely flat. 
This isn’t rocket science and shouldn’t be that difficult for plastic surgeons to decipher. Regardless, you need to ask yourself if you’re willing to redo the operation to try to change the outcome. If the outcome is related to visceral fat, then weight loss is mandatory in order to get an improvement.
Best,
Mats Hagstrom, MD

Lower abdomen bulge 16 months post tummy tuck - what could this be and what are my options to correct this? (photos)

Answers (9)

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