How can I treat this upper bulge 6 months after tummy tuck and muscle repair? (Photo)

Question

I’m 6 months post op after tummy tuck and muscle repair I have a soild hard lump in my upper abdomen it dosnt cause me and pain or discomfort it just looks awful I spoke to my surgeon he said it’s just swelling but it has being like like since the day I had surgery and it hasn’t got any better it feels like I have a rock stuck in their also after surgery my belly button popped out after about 2 weeks they gave me a little plug to pop in their to hold it in But still theirs no change

David Branch, MD · Answer

Jodiestevo, a thorough in-person evaluation would be essential to evaluate your abdominal bulge. I am sure there is some degree of swelling at 6 months, but I suspect you had fascial tightening which can tend to "bunch" the skin in the midline if it is not undermined and redraped properly. This would be seen immediately after surgery. It is also possible that you may have a fluid collection, or seroma, though not typically present the day of surgery. There is lastly, possibility of a hernia or failure of the muscle repair structures. It would be important to know if you strained or lifted something after the procedure and then noticed this bulge. Ultrasound or additional imaging may be helpful in this situation to determine exactly what is happening. Hope this helps!

Daniel Barrett, MD · Answer

Dear jodiestevo,
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

Connie Hiers, MD, FACS · Answer

I would suggest getting an ultrasound to see if fluid, fat, or a weak area of muscle is causing that bulge. Fluid can be drained, and liposuction can remove excess fat.

Camille Cash, MD · Answer

If you are having your upper abdomen protrude outwards it may be that abdominal repair was not performed on that area.  It could also be visceral/internal fat which produces that look.  At 6 months post op if you have not had any improvement it is not likely a result of swelling.

Mats Hagstrom, MD (license on probation) · Answer

To make an accurate assessment on the outcome of any plastic surgical procedure we need to see before and after pictures.
If you don’t have proper it before and after pictures and then ask your surgeon to forward the ones they took.
I don’t think anyone can give you a good assessment based on pictures alone so you’ll probably need to do it in person a second opinion consultations.
Bulging of the upper abdomen after a tummy tuck usually forms due to either the patient being barrel chested with aggressive muscle tightening of the lower abdomen, or individuals with excess visceral fat making the upper abdomen bulge after reducing intra-abdominal volume from muscle tightening.
Usually the bulging scene from those two conditions is slightly different than your outcome. it’s important to know if you had liposuction done during the procedure. It’s also important to differentiate how thick the subcutaneous fat layer is and get a clear understanding of the contour of the abdominal wall itself. to do that requires an examination.
Other potential explanations could be an undrained seroma. Were drains placed during surgery?
Your belly button stalk should’ve been cut shorter so it’s pulling in on the skin rather than the other way around. Different people have different types of belly buttons and some are easier to work with than others. Individuals with very deep belly buttons are more favorable and easier to work with for this procedure. for those who have a shallow belly button the stalk of the belly button should be anchored to the muscle fascia to get a pulled in appearance.
Depending on the shape of your belly button itself whether it’s deep or shallow will dictate how easy it will be to revise.
At six months you no longer have swelling and swelling would present in your lower abdomen not your upper abdomen due to gravity.
If your surgeon is not willing to take responsibility for his or her work then seek second opinion by having proper in person second opinion consultations.
For a second opinion consultations patients should come prepared with copies of their operative report and all before and after pictures. These are all available from your surgeons office if you request them as they are part of your medical record.
Best,
Mats Hagstrom MD

Jeffrey C. Hamm, MD - Account Suspended · Answer

Hi and welcome to our forum!
From your photo, I note the fullness of the upper abdomen as well as hypertrophic scarring of the belly button.
The bulge may represent a seroma of the abdomen, disruption of the supraumbilical muscle repair, or post surgical swelling. An examination is required to differentiate. In situations where the examination does not provide a clear answer, an MRI of the abdomen may provide a clue.  
A hypertrophic scar represents an abnormal response to tissue injury, resulting in deposition of excess collagen. Its prevalence is increased after infection or in wounds under mechanical stress. The scar doesn't grow beyond the boundaries of the original skin injury. 
There are non-invasive and invasive methods to treat this entity. Hypertrophic scars often spontaneously regress with time, the final scar noted when the redness of inflammation has subsided (usually at 12-18 months). Keloids may become inactive but usually do not regress.
The application of pressure and immobilization of a scar with silicone gel sheeting appears to hasten resolution of the process. Various creams are available, but their efficacy is questionable.
Laser treatments are available with varying degrees of success. 
Injection of corticosteroids directly into the scar may flatten the scar and alleviate symptoms, but may also broaden the scar and cause pigmentary change in the skin locally. For this reason, we usually delay its use for as long as possible.
Surgical scar revision is an option to consider if regression is not noted at 18 months after the procedure. This is often successful in treating hypertrophic scars, but, on the other hand, keloid recurrence is quite common. 
Speak about your treatment options with your plastic surgeon.
Best wishes...

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