15 months post op and still “swelling" - what can I do? (photos)

Question

To start off, six days after my surgery I felt like I had an abnormal amount of swelling and brought it to my PS and she vehemently and repeatedly assured me that it was normal. However, here I sit, 15 months later with this bulge that I feel is not “normal”. She sent me for CT which she reviewed and said it was fine and no issues noted, however she has basically dropped me since and never held my 1 year post op appt. or any other follow ups.

Sean T. Lille, MD · Answer

Dear Girl_in_Black, I'm always very sorry to hear when a surgeon dismisses a patient that feels they are having issues. It is not expected to be swollen at 15 months post-op. Please seek a second opinion with another reputable surgeon.

Nelson Castillo, MD · Answer

Thank you for sharing your question.  After 15 months this is unlikely to be swelling and an underlying cause needs to be determined through an in-person examination of your tissues.  Most likely this is failure of your muscle repair, or continued laxity that will require a surgical revision.  Seek out board certified plastic surgeons to get the best advice.

Daniel Barrett, MD · Answer

Dear Girl_in_Black,
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

Camille Cash, MD · Answer

It is not common to have swelling at 15 months post op.  I'm sorry that your surgeon is no longer responding to you.  I encourage you to visit with another board certified plastic surgeon near you to determine what may be the underlying cause.

Connie Hiers, MD, FACS · Answer

You did not post your before photos, but the swelling was probably present. An examination is needed to see if you have residual fat or internal swelling. Internal swelling is not treated with surgery.

Scott C. Lindsay, DO · Answer

Thanks for your question! I might suggest getting a second opinion. I suppose there's always a possibility that your diastasis needs to be looked at and perhaps repaired. Good luck!

Darryl J. Blinski, MD · Answer

Nice posted photos. My guess is excess lower abdominal fat and or failed lower muscle plication or both.. Best obtain ultrasound of lower abdomen. Lipo with mini incision to re do muscle repair. Fee $15,000+ Best to virtual consult with...

Mats Hagstrom, MD (license on probation) · Answer

To make an assessment on the outcome of a plastic surgery procedure we always need to see proper before and after pictures. If you don’t have before, and after pictures, then I suggest you ask your provider to forward me the ones they took.
There are four variables that determine what summers abdomen looks like. This is generally true whether someone has had previous cosmetic surgery or not. If there is issues with the contour of the abdomen, it’s still almost always comes down to one or more of these for variables.
The four variables that determine what someone’s abdomen, looks like our abdominal skin, laxity, excess, subcutaneous, fat, muscle separation from previous pregnancies, or excess visceral or intra-abdominal fat.
Your tummy tuck treated the abdominal skin laxity, and you don’t appear to have excessive amounts of subcutaneous fat. Insufficient muscle tightening is unusual, but it is a potential reason for having a bulging abdomen. By far the most common reason people have a bulging abdomen after a full tummy tuck is because they have excess visceral fat. This can usually be identified a pre-operative pictures and it’s not difficult to diagnose.
Your a domino wall is bulging, and that typically can only come from laxity of your domino wall, or excess of visceral fat, or a combination of both. Since you’ve had a tummy tuck, you’ve had muscle tightening, so muscle separation should not be an issue, but it is possible that muscle tightening was insufficient. This is an unlikely explanation.
The most likely, and the most common cause for someone having a bulging abdomen after a full tummy tuck, is the presence of excess visceral or intra-abdominal fat. This should’ve been assessed during your initial consultation. Individuals who have excess visceral fat will not get a flat abdomen despite aggressive muscle tightening. These individuals should be told the inherent limitation of the procedure, and should be told to lose weight before considering having a tummy tuck. It could be a insufficient muscle tightening, and it’s not too difficult to differentiate between the two.
The easiest way is to take pictures of your abdomen laying on your back. You may need to set the timer or have someone else take pictures for you. If your abdomen goes completely flat when you lay on your back, relaxing your abdominal muscles, then visceral fat is probably not contributing significantly. If your abdomen still has a bulge even when you’re laying flat on your back and then this is a clear indication that visceral fat is causing the problem.
Visceral fat can only be reduced by weight loss, and this is most likely your best option for getting a flat abdomen. You are no longer swollen 12 months after surgery. 
This isn’t rocket science and most competent plastic surgeons should be able to differentiate between the four variables that contribute to what the abdomen looks like.
The fact that you did not show up for an appointment, does not allow allow your provider to abandon you. If you still have issues related to a procedure they performed. Failing to maintain a follow up and addressing your concern can be considered abandonment and it’s a pretty serious ethical charge that both doctors and institutions usually take seriously.
Your doctor may have a right to charge you for a no-show visit if they have a no-show policy in place. Contact your plastic surgeon and ask them to schedule a follow up appointment with you.
How many follow up appointments have you had with your provider?
Since you’ve had this problem ever since the procedure, I would imagine more frequent follow ups would be a normal course of action.
Best,
Mats Hagstrom, MD

Joshua Jacobson, MD - Account Suspended · Answer

Hi. Did you have a drainless tummy tuck? I don't see any drains in the post op picture. If that was the case, you most likely developed a seroma which is a collection of fluid that needs to be drained as soon as it is noted.

15 months post op and still “swelling" - what can I do? (photos)

Answers (9)

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