What could have caused a pooch after tummy tuck and what can I do to correct this? (photos)

Question

I had my surgery 11/2021. Had some complications with my incision. It got infected. They had to dig the staples out. When they took the anchor it left a big hole in the center. Was sorta a nightmare. My doctor didnt recommend massages. Said they were not needed. Now I have this weird pooch that sticks out. Is there a reason why and a way to fix it?

Semih Yildiz, MD, FEPOBRAS · Answer

A localized pooch after a tummy tuck can come from several different causes, and your history of wound infection and delayed healing makes scar tissue an important possibility. Infection or an open wound can lead to tethering, thick internal scar, contour depression in one area, and a relative bulge next to it.

Other possibilities include residual fat, looseness of the abdominal wall or muscle repair, a small seroma or scar pocket, a hernia, or simply skin/fat that healed with an uneven pull. The photos show a contour issue, but they cannot tell whether the problem is mainly skin, fat, scar tissue, or the abdominal wall.

At this stage, massage alone is unlikely to correct a fixed pooch from surgery in 2021. You would need an in-person exam by a board-certified plastic surgeon, ideally with review of your operative report if available. If there is any concern for hernia, fluid, or abdominal wall laxity, ultrasound or CT imaging may help.

Correction depends on the cause. Options may include scar revision, release of tethered scar, limited liposuction, direct excision of extra tissue, revision of the muscle repair, or hernia repair if one is present. A revision plan should be based on the exam rather than guessing from photos alone.

Daniel Barrett, MD · Answer

Dear Roxy5180,
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

Alan Gonzalez, MD, FACS · Answer

Hello @Roxy5180, thank you for your question.  It's not uncommon for patients to experience complications or unexpected results after a tummy tuck procedure. Factors such as surgical technique and post-operative care can affect the final outcome. If you're experiencing a pooch after your tummy tuck surgery, it's important to consult with a board-certified plastic surgeon  and to evaluate if there is something else at a systemic level to make you still swollen. That way  the cause of the pooch can be determined and the best course of action for correcting it, which may involve additional surgery.  Best wishes! Alan Gonzalez MD, FACS.  American Society of Plastic Surgery Member (ASPS), International Federation for Adipose Therapeutics and Science” Member (IFATS), American Society of Plastic Surgery Member (ASPS), Colombian Society of Plastic Surgery member (SCCP)

Miguel Mota, MD · Answer

Hello and thank you for posting. It is hard to say why but I’m sure the infection had something to do with it. The good news is that this is an easy fix! Scar revision with liposuction should take care of your concerns. I believe your incision should be not only straightened but lowered as well! Make sure to address both these issues and you will have great results.

Best of luck,
Dr. Miguel Mota

Best of luck,
Dr. Miguel Mota

Bryan Curtis, MD · Answer

The development of a "pooch" or bulging after a tummy tuck can be influenced by various factors, and it's important to identify the specific cause to determine the most appropriate corrective measures. Here are some potential reasons for the development of a pooch after a tummy tuck and possible corrective actions:1. Incomplete Muscle Repair: If the abdominal muscles were not adequately tightened during the initial tummy tuck procedure, it can result in a lax or weak muscle wall, contributing to a pooch. Corrective surgery may involve revisiting the muscle repair to enhance abdominal contour.2. Inadequate Fat Removal: If there was insufficient removal of excess fat during the tummy tuck, localized fat deposits may contribute to the appearance of a pooch. Liposuction or targeted fat removal may be considered as a corrective measure.3. Seroma or Fluid Accumulation: Fluid accumulation (seroma) in the abdominal area can lead to swelling and a bulging appearance. Drainage of excess fluid may be necessary to address this issue.4. Weight Gain: Significant weight gain after a tummy tuck can contribute to the development of a pooch. Maintaining a stable and healthy weight is crucial for long-term results.5. Poor Skin Elasticity: In some cases, poor skin elasticity may contribute to a less-than-ideal outcome. Skin tightening procedures or revision surgery may be considered to improve skin tone and contour.To address a pooch after a tummy tuck, it's crucial to consult with your plastic surgeon. During a consultation, the plastic surgeon will evaluate the specific issues contributing to the pooch and recommend an appropriate course of action based on your individual circumstances.Revision surgery, if deemed necessary, may involve techniques such as additional muscle tightening, liposuction, or other procedures tailored to address the underlying causes. It's essential to have realistic expectations and understand that revision surgery may be more complex than the initial procedure.Always communicate openly with your plastic surgeon about your concerns, and follow their guidance regarding postoperative care and recovery to optimize results.

Connie Hiers, MD, FACS · Answer

An examination is needed to be certain, but I suspect you have some fat in the area which can be treated easily with liposuction. Fat in that area is not treated with liposuction at the same time as the tuck for safety reasons for the skin.

Camille Cash, MD · Answer

It's difficult to know what lead to your abdominal contour.  It could be related to the post op infection.  For improvement you can consider a scar revision and either a little liposuction or removal of more tissue.  An examination is recommended to determine the best way to proceed.

Nancy de Kleer, MD, FRCSC (Plast) · Answer

It's disappointing to have a pooch after a tummy tuck and we do see this from time to time.  This is likely related to poor healing, which may be related to the infection that occurred.  The way to fix it is with liposuction and normally it comes out very nicely once this is done.

Darryl J. Blinski, MD · Answer

Based on posted photos you need full TT revision to correct scarred pouch you have after infection postop. Fee $5,000Best yo virtual consult with….

Mats Hagstrom, MD (license on probation) · Answer

To make an accurate assessment on the outcome of a plastic surgery procedure we always need to see proper before and after pictures. Without seeing before pictures, we can’t access the outcome of the procedure.
If you don’t have before, and after pictures and ask your surgeon to forward, the ones they took.
Abdominal contour is generally related to one of or more of four variables. These are issues related to skin laxity, subcutaneous fat distribution, muscle separation from previous pregnancies and excess visceral fat. 
In your case, there’s probably some scar tissue contraction from the wound healing issues.
To get an accurate assessment and better understanding if revision surgery is indicated, I suggest having multiple in person consultations with local board-certified plastic surgeons in your community. There are generally two variables that determine the outcome of cosmetic surgery procedures. Those two variables are patient’s candidacy and the scale of the surgeon. Your candidacy, for the procedure would be indicated for assessed by seeing your before pictures. Your current indication for candidacy for revision surgery would require an examination to assess the position of your muscle, while to see if visceral fat is contributing, or if subcutaneous fat, may be contributing to a contour.
You’re abdominal contour depression related to scar tissue contraction could most likely be improved with a scar revision.
I recommend patients have multiple in person consultations to help find the best provider. Plastic surgery outcomes are highly provider dependent, and patients should put in a significant effort in finding the best provider. I suggest most patient start the process by having at least five in person consultations, to begin bedding service to find the best provider.
During each consultation, ask each provider to open up their portfolio of before, and after pictures and ask them to show you previous cases of patients who had similar body characteristics to your own. Ask providers to show you examples of excellent outcomes, average outcomes, and outcomes that did not turn out, as well as they had hoped. Providers maybe apprehensive to do this and may prefer to show you pre-selected images representing the best results of their career. Being shown pre-selected “Show and Tell” type pictures does not give sufficient information to get a clear understanding of what average results like in the hands of each provider. 
An experience provider should have no difficulty showing you the before and after pictures of at least 50 previous patients.
Is it fairly complex major operation. With the procedure comes risk of complications, including wound, healing complications like you described.
Best,
Mats Hagstrom, MD

What could have caused a pooch after tummy tuck and what can I do to correct this? (photos)

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