Do I Need A Revision - 1 Year Post-op, Belly Button is Protruding (photos)

Question

Hi! One year ago I had an abdominoplasty with DR repair and umbilical hernia repair (no mesh). Although there is great improvement , I feel as though the area above the belly button protrudes more than it should. I was told there is little fat so it could be weak tissue or just how my organs lay. I am consistent with doing Pilates to increase core strength. Is this something a revision can fix?

Shlomo Widder, MD · Answer

Dear Kris may,
   Thanks for posting your pictures and sorry for the less than optimal outcome. From observing your pictures, it appears it appears that you have abdominal muscles laxity, mainly in the epigastric (upper abdomen) area . The most common reasons for that condition in people with your anatomy are either resuming strenuous activity (like Pilates etc) too early, or not using protective binder that prevent stretching of the muscles repair.
   So, the answer to your question is indeed, a revision with muscles repair will eliminate the bulge and flatten your stomach further. Obviously, you will have to follow post operative instruction in order to avoid recurrence of the muscles laxity.
   Always, consult with experienced board certified plastic surgeons who operate in accredited surgery center for your safety. Most importantly, check the before and after pictures in the photo gallery, to make sure that they are numerous, consistent and attractive with flat stomach, narrow waists, nice belly button, improved body posture and low scar.
                Best of luck,
                             Dr Widder
                    widderplasticsurgery.com

Daniel Barrett, MD · Answer

Dear krismay05,
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

Darryl J. Blinski, MD · Answer

Based upon the nicely posted photos my impression of possible reasons and treatments are: 1. Muscle repair in supra umbilical area was not done? 2. The repair broke apart? Treatment is only reopening the TT scar with re dissection to expose the central mid/upper abdominal areas, then re suture in layers the recti edges. Fee in $10,000 ranges.

Mats Hagstrom, MD (license on probation) · Answer

Generally speaking there are three reasons why someone may have a bulging upper abdomen after a full tummy tuck.

The first reason is excess visceral fat. Muscle tightening with a tummy tuck reduces the intro domino cavity and the volume needs to go somewhere. Lower abdominal muscle tightening is usually very effective and the bulging because of this often displace in the upper abdomen.

Weight loss will reduce visceral fat and if the condition improves with weight loss then visceral fat is probably at least part of the explanation.

The second reason is individuals who are barrel chested or have a sternum that sits significantly forward in relationship to their pubic bone.

Muscle tightening typically creates a beeline between the rib cage and (the sternum typically sits in front) to the pelvis (pubic bone often represents the front of the pelvis). In individuals this chest is more barrel shaped or round with forward projection surgeons should predict that the upper abdomen is likely to bulge as a result of aggressive muscle tightening.  One way to compensate for this is the back off and do less muscle tightening of the lower part of the abdomen.

The third potential reason is simply less than ideal muscle tightening especially overly aggressive tightening of the lower abdomen. Almost always one or both of the above variables are the underlying reason.

One way to assess if the problem is caused by excess visceral fat it’s just see how much pressure it takes to hold the abdomen flat where is bulging out.

If it takes a fair amount of pressure to push your abdomen flat and doing so creates a sensation of having a full abdomen with difficulty taking a deep breath then visceral fat may be the primary cause.

Without an examination is difficult to give you a better assessment but almost always this comes down to visceral fat for the relationship between the rib cage and the pelvis(Plus minus if this was compensated for during the procedure)

Different plastic surgeons may have different opinions on this. This is just based on my experience.

Best,

Mats Hagstrom MD

Do I Need A Revision - 1 Year Post-op, Belly Button is Protruding (photos)

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