Is it possible for my stomach to be fixed? 4 years post op, stomach has not gotten smaller (photos)

Hello Cool845668 in Pittsburgh. Thank you for your question regarding the persistent abdominal issues you've been experiencing since your tummy tuck four years ago.

Thank you for sharing your history and the photos. After reviewing your description and the images, it appears you are dealing with a distended abdomen, which can be quite distressing, especially after undergoing significant surgeries like a tummy tuck and colon resection.

The distention you describe could be attributed to several factors:

Visceral Fat: Often, a "ball-like" appearance of the abdomen post-tummy tuck can be due to visceral fat, which is the fat located inside the abdominal cavity and around your internal organs. This type of fat cannot be addressed through tummy tuck surgery or liposuction.

Weak Fascia: The fascia, which is the connective tissue over your muscles, may have been weakened or not adequately tightened during your initial surgery, or it may have loosened over time.

Post-Surgical Changes from Colon Resection: Major surgeries like a colon resection can significantly affect the structure and function of the abdominal cavity, potentially leading to changes in how fat is distributed and how the abdominal wall appears.

To better understand the underlying cause of your abdominal shape, I recommend obtaining an MRI or CT scan. These imaging studies can help determine whether the fat contributing to the bulge is subcutaneous (above the muscle) or visceral (below the muscle and around the organs).

If the imaging shows that the issue is predominantly due to visceral fat, the most effective treatment is weight management through diet and exercise. A diet that focuses on high protein intake, such as a ketogenic or carnivore diet, may be beneficial. These diets reduce carbohydrate intake, which can help reduce visceral fat. Additionally, medications like Ozempic and Zepbound have shown promising results in managing weight and might be worth discussing with your healthcare provider.

Given your complex surgical history, including the colon resection, it's also crucial to consider any additional therapies you might have undergone, such as chemotherapy or radiation, as these can also impact your recovery and physical changes.

At this stage, most plastic surgeons would advise against further surgical interventions until your weight and visceral fat levels are optimized. Engaging in both aerobic and anaerobic exercises will also be crucial in addressing your abdominal profile.

Good luck as you navigate these challenges. I hope this response helps provide clarity and direction for addressing the issues with your abdomen.

Sincerely,

J. Timothy Katzen, MD, FASMBS, FICS
Plastic Surgeon

Hello; your pre-operation photos; it suggests for that; there is abdominal fat, rectus muscle diastasis and perhaps, some excess visceral fat. In Abdominoplasty; that is performed for patients; with excess visceral fat; in order to prevent patients from having breathing problems after surgery; rectus plication; that is, muscle repair; may not occur. If it is; it causes for bulging in the abdomen. Sometimes, even if abdominal muscle repair is performed; a bulging, can be seen in the abdomen. Because, in some patients, abdominal muscles and fascia; they can be very thin and tear easily. In such patients, even if muscle repair is realized; stitches; which are easily tear the fascia; can relax. It's as; if no repairs were done. The flattened appearance of your belly button; it is an indication that; your diastasis persists or that your muscles are very weak. In such cases, after repairing for the abdominal muscles, a material; that is called "prolene mesh"; is placed on it and strength; can be increased in the sewing line.