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

Question

I had a tummy tuck almost 4 years ago. It came out horrible. I have since lost about 30 pounds and everything has gotten smaller except my stomach. Since the tummy tuck and muscle repair my stomach has just looked like a ball. It's so misshapen I don't know if there's any fixing this. I do have more scars now because I did have a colon resection since the tummy tuck. I added pictures of before, after I was healed and then now

Camille Cash, MD · Answer

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.

Daniel Barrett, MD · Answer

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

J. Timothy Katzen, MD, FACS · Answer

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

Gerald Minniti, MD, FACS · Answer

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.

Zoran Potparic, MD · Answer

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.

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

Answers (9)

Answer: Intra abdominal fat

Answer: Intra abdominal fat

Answer: Aggressive liposuction, possibly skin excision, weight loss?

Answer: Aggressive liposuction, possibly skin excision, weight loss?

Recommended reading

Everything you need to know about Tummy Tuck Revision

Our mission is to create a world where every investment in modern beauty is Worth It.

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

Answers (9)

Answer: Intra abdominal fat

Answer: Intra abdominal fat

Answer: Aggressive liposuction, possibly skin excision, weight loss?

Answer: Aggressive liposuction, possibly skin excision, weight loss?

Browse related questions

Recommended reading

Everything you need to know about Tummy Tuck Revision

Our mission is to create a world where every investment in modern beauty is Worth It.