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

The surgeon's error was not in execution of the surgery but judgement to do the surgery in the first place. You clearly had too much fat inside your organ cavity, making it impossible to flatten your abdominal muscle wall by rectus plication or any other means. You will need to lose weight to melt your intra-abdominal fat stores not just for cosmetic purposes, but to also decrease your chances of heart attack and stroke. I strongly recommend using GLP-1 type drugs to assist you in this important endeavor.

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

Dear Cool845668,
congrats on the weight loss! Generally speaking, you want to reach your goal weight before you consider a tummy tuck, otherwise your results will be suboptimal if you continue to lose weight after the surgery. I understand your concern. However, without a proper assessment, it would be difficult to determine what is 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

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.

There is no doubt that there is a lot of fat tissue in your anterior abdomen; liposuction is the way to correct that ; you may also need additional, conservative skin excision, but I should wait with it for few months after liposuction. It is questionable how much of intra-abdominal fat (inside, around organs) you have, since that may be a significant contributor to your abdominal bulge? In person consultation with an experienced board certified plastic surgeon is recommended. Good luck.

Go back to your surgeon or a new one to check on your hernia repair. A CAT scan may also be needed and weel as an examination.

If you had a tummy tuck with muscle repair the contour of your tummy is likely from visceral fat. This is the internal fat behind the muscle wall that surrounds your organs. This cannot be addressed by liposuction or a tummy tuck but should improve with further weight loss.

Dear Cool,
It seems that perhaps there was too great an expectation for what you could achieve with a tummy tuck at your weight and fat distribution 4 years ago. We do not know the reason for your colon resection and was something with the colon contributing to the protuberance of your abdomen? At any rate, your abdomen appears much improved after the 30 lb weight loss. A recommended course of action would be to continue/complete your weight loss plan, get to your goal weight, maintain it for at least 6 months and then seek consultation with an American Board of Plastic Surgery board certified plastic surgeon for an examination and action plan. Good luck!

Cosmetic surgical outcomes are primarily based onto variables.
The first is the patient’s candidacy for the procedure and the second is the choice of provider.
In order to understand your outcome we need to first look at your candidacy for the procedure in the first place.
There are four tissue variables that determine what someone’s abdomen looks like.
In other words, if somebody doesn’t like the way, their belly looks the problem is always one or more of four different tissue layers.
The four variables to determine what the abdomen looks like are the following.
1) abdominal laxity typically due to previous pregnancies or weight loss.
2) excess subcutaneous fat.
3) muscle separation from previous pregnancy.
4) excess visceral or intra-abdominal fat.
Now, let’s take a look at how each of these valuables are best treated.
A tummy tuck specifically treats abdominal skin, laxity, and muscle separation from previous pregnancies.
It is the quintessential correct procedure for pregnancy related changes.
Excess subcutaneous fat can be reduced with liposuction or potentially with weight loss.
Excess visceral or intra-abdominal fat can only be lost through weight loss.
There is no surgical procedure to reduce excess visceral fat.
In your case The number one culprit or variable is excess visceral fat
This means you were never a good candidate for a tummy tuck in the first place without preview weight loss first.
Excess visceral, fat and muscle separation can look fairly similar.
It isn’t all that difficult to differentiate between the two and this should be done during in person consultations with plastic surgeons before considering scheduling surgery.
Your plastic surgeon should have made an accurate assessment and told you that without weight loss, you would not have a good outcome and would have a bulging abdomen.
You were never a good candidate for a tummy tuck to start with unless you lost weight first.
To differentiate visceral fat from muscle separation patients can do the following.
One way to differentiate is to see what your abdomen looks like when you lay on your back.
If the problem is related to muscle separation then, when laying on your back, your abdomen should be slightly concave and flatten out completely.
If it still bulges, when laying on your back, then visceral fat is most likely the contributing variable.
Another way to differentiate is to press your abdominal wall until it’s flat.
A flat abdominal wall should create a B line between your rib cage and your pelvic bones.
In other words, a flat abdominal wall should make a B line from your sternum to your pubic bone.
If your abdominal wall sits in front of this, then you have abdominal bulging.
If you take your non-dominant hand and press your abdominal wall until it’s flat (it lines up with the sternum and pubic bone) and you can hold this position for several minutes without your arm getting tired then the problem may not be excess visceral fat.
If pressing your abdomen, flat takes a lot of pressure and it makes you feel like you can’t take a deep breath, then visceral fat is the problem.
Considering that you’ve already had muscle tightening, the problem is without question visceral fat in your case.
You still have the potential for a flat abdomen?
It will require further weight loss.
The amount of weight loss needed to get a flat abdomen. Should be fairly easy to determine.
I suggest you take pictures and then work on weight loss.
For every interval of weight loss for example, 5 pounds take a new set of pictures and see what your abdomen looks like.
if your abdomen is still bulging, then you still need to lose more weight.
If you eventually get to the point where your abdomen is flat, then you’ll know what the ideal weight is to have a flat abdomen.
There is no surgical treatment or medical treatment for excess visceral fat.
It is genetically predetermined and can only be managed with weight loss.
Best,
Mats Hagstrom, MD