Abdomen looks just as large after TT. What are my options?

Question

I had abdominoplasty with muscle repair a few months ago and as the weeks have gone by, my abdomen gets larger. It was relatively flat at first but at this point my abdomen is just as round as it was before the surgery, minus the loose skin. I look around 6 months preg. The diastasis recti appears to be still closed when I'm sitting up. My BMI is around 29 and I have not gained any weight since my surgery. AIso did have a hernia that was repaired during my surgery. I'm so frustrated.

Emmanuel De La Cruz, MD · Answer

If your abdomen appears just as large after a tummy tuck (TT), there are several potential reasons and corresponding options to address this issue:

Swelling and Fluid Retention: It's common to experience swelling after a tummy tuck, which can persist for several months. If swelling is the cause, continuing to wear compression garments, receiving lymphatic drainage massages, and following your surgeon's post-operative care instructions can help reduce it. Consult your surgeon to rule out complications like seromas.

Residual Fat Deposits: If there are areas of residual fat that weren't adequately addressed during the initial procedure, liposuction might be an option. Liposuction can target specific fat deposits and improve the overall contour of the abdomen.

Muscle Laxity: If the abdominal muscles weren't tightened sufficiently during the initial tummy tuck, or if they have separated again, a revision surgery might be necessary to re-tighten the muscles.

Excess Skin: Sometimes, not enough skin is removed during the initial surgery, leading to a less dramatic result. A revision tummy tuck can remove additional excess skin.

Weight Gain: Post-surgery weight gain can cause the abdomen to appear larger. Maintaining a stable weight through a balanced diet and regular exercise is crucial for optimal results.

Scar Tissue: Internal scar tissue can sometimes affect the appearance of the abdomen. Consulting with your surgeon can help determine if this is a factor and what can be done about it.

Steps to Take:
Follow-Up Consultation: Schedule a follow-up appointment with your surgeon to discuss your concerns. They can assess the situation and provide specific recommendations based on a physical examination and your surgical history.

Imaging Studies: In some cases, imaging studies like ultrasound or MRI can help identify issues such as fluid collections or muscle separation.

Consider a Second Opinion: If you're not satisfied with the responses from your original surgeon, seeking a second opinion from another board-certified plastic surgeon can provide additional insights and options.

Healthy Lifestyle: Continue to follow a healthy diet and exercise regimen to maintain your weight and overall health, which can positively influence your surgical results.

Revision Surgery Options:
Liposuction: To remove any remaining fat deposits and improve contour.
Revision Tummy Tuck: To address issues with muscle laxity or excess skin.
Non-Surgical Options: In some cases, non-surgical treatments like CoolSculpting or other body contouring procedures can help improve the appearance of your abdomen.
Consult with your plastic surgeon to develop a tailored plan that addresses your specific concerns and helps you achieve your desired results.

Randal Haworth, MD, FACS · Answer

I understand your frustration with the changes you've noticed in your abdomen following your abdominoplasty with muscle repair surgery. It's important to consider a few factors that could contribute to your current situation.

Firstly, it's worth mentioning that some swelling and fluid retention are common after abdominal surgery, including abdominoplasty. This can temporarily affect the appearance of your abdomen, making it seem larger than expected. Swelling typically subsides over time, but it can take several months for the final results to become apparent.

Another consideration is the presence of diastasis recti, which is a separation of the abdominal muscles. Although you mentioned that it appears to be closed when you're sitting up, it's possible that the repair hasn't fully addressed the underlying muscle laxity. This can contribute to a rounded appearance in the abdomen, even without the presence of excess weight.

Additionally, the presence of a hernia and its repair during your surgery could also impact the overall appearance of your abdomen. Depending on the size and location of the hernia, as well as the technique used for repair, it may influence the final outcome and contribute to the appearance of abdominal fullness.

It's important to discuss your concerns with the surgeon who performed your abdominoplasty. They are in the best position to evaluate your specific case, examine your abdomen, and provide further guidance. They can assess if there are any complications or issues that need to be addressed and determine the most appropriate course of action to achieve the desired results.

If you remain dissatisfied after discussing your concerns with your initial surgeon, it might be beneficial to seek a second opinion from another qualified and experienced plastic surgeon. They can provide an independent evaluation of your situation and offer alternative treatment options or recommendations.

I hope this helps,
best of luck !

Daniel Barrett, MD · Answer

Dear ChristaneBean,
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

Connie Hiers, MD, FACS · Answer

You did not post before and after photos, so I recommend that you go back to your surgeon and discuss your concerns and options.  If you have internal swelling, like your colon, this is related to your diet and not to surgery.

Camille Cash, MD · Answer

An exam or photos is really needed in your situation.  The contour could be related to swelling, a collection of fluid, internal fat, or muscle repair failure to name a few potentials.  The correction will vary based on the underlying cause. I encourage you to visit with your surgeon for an evaluation of your concerns.

Mats Hagstrom, MD (license on probation) · Answer

To make an assessment on the outcome of a cosmetic surgical procedure we always need to see proper before and after pictures. If you don’t have before, and after pictures and ask your surgeon to forward the pictures they took.
There are two variables that determine cosmetic surgery outcomes. The first is the patient’s candidacy for the procedure in the first place and the second is the skill and experience of the provider.
When results are less than patients had hoped, for the answer is almost always within one of those two variables. Either patients were not a good candidate for the procedure, or their candidacy was inherently, limited or the surgeon, lacked sufficient, skill and experience.
The most common reason patients fail to get a flat abdomen after a full tummy tuck is the presence of excess visceral fat, which should have been diagnosed and discussed during an in person consultation.
Consider re-posting with proper before and after pictures or schedule a few second opinion in person consultations with other plastic surgeons in your community.
Best,
Mats Hagstrom, MD

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