What to do when muscle repair fails and comes undone? (Photo)

Question

My doctor determined the muscle repair performed during the TT has come undone. I followed the post-op instructions (no heavy lifting, wore the binder 6 weeks). I'm 14 weeks post surgery. I have the following questions -Is the damage done or will it continue to "unravel" & go back to its pre-surgery condition? -The upper abdomen is bulging, will the lower abdomen eventually bulge also? -At this point is there anything else I can do to attempt to keep it together? Would wearing the binder help?

Brent Moelleken, MD · Answer

Only your doctor knows exactly what is going on with your fascia, what the strength of the fascia is.In general, the number one cause of a bulge in the abdomen after a tummy tuck is fat inside the abdomen, so-called intraabdominal fat.  The fat occupies space and must go somewhere.  The answer is not to create some type of armor plated plication, it is to lose weight.  Only that will allow a proper repair to succeed.

Kenneth Hughes, MD · Answer

If the plication failed and the surgeon thought the fascia was weak at the time of repair, then mesh overlay with plication makes sense.  There are many types of mesh, which the surgeon should be able to select. There is always a risk of recurrence.  Mesh can always get infected.  Some surgeons use a dermal matrix overlay.  However, these items are much more expensive, and may be prohibitively so for a cosmetic case.  You should discuss all of these items with your PS and wait until six months to reevaluate.Kenneth Hughes, MD, Board Certified Plastic SurgeonLos Angeles, CA

Austin Hayes, MD · Answer

It's hard to say without knowing the details of your your surgery or seeing your preoperative photographs. Before attempting a repair of the muscle, it's important to make sure that you have healed completely.  It's important to try to identify the cause of the breakdown. Any modifiable causes should be addressed for any revision surgery. Good luck with the process.

Gerald Minniti, MD, FACS · Answer

Hello,If in fact this is true, there is nothing you can do surgically until you've healed completely. Things like fluid collections (seromas) and swelling need to be ruled out as a cause.  Finally, intra-abdominal fat should be assessed. No repair will be maintained if there is too much intra-abdominal pressure from excess fat stores around your organs. If this is the case, then no revision surgery should be attempted until weight loss has occurred. Best of luck!

Tim Sayed, MD, MBA, FACS · Answer

Your surgeon is the best judge of what may be going on here based on understanding what you looked like preop and how you healed in the early weeks. If the muscle plication has pulled through/unraveled (rare, but it can happen), it is possible the part above the belly button tore through but the part below is intact, or vice-versa (depending on surgeon's technique for repairing the muscle). If this is what happened, it will not tighten itself and you would require revision surgery to repeat the muscle plication. However, it is also possible the bulginess you are seeing is related to intrabdominal fat which is not removed in a tummy tuck, and is only correctable with diet and exercise. You should discuss an action plan with your surgeon and if you are not happy, consider a second opinion.

Curtis Wong, MD · Answer

as you have... but your surgeon has the advantage of examining you and knows the quality of your tissue when you had your procedure.  If you are beyond 6 weeks from surgery, you can feel your tummy when doing a simple crunch and if the muscles do not have a vertical gap in the midline your sutures did not come undone and its more likely your bulge is from excess skin and fat that gets pushed to the midline when pulling the muscles together and its very common when the plication is significant.  Continue to focus on healing and when you are released to do what you like, ask your surgeon to show you where it was disrupted and how he determines that... and if truly disrupted, then you are looking at a major revision.   Wearing a binder will not really help much.

Parag Butala, MD · Answer

Thank you for your question. It does appear that a portion of your plication has failed. With regards to other options, you should have a detailed discussion with your plastic surgeon. A possibility is to revisit surgery once you are several months out. This would likely be closer to six months out of surgery. At that time, another attempt at plication could be performed, or you could have any of a number of forms of mesh added to reinforce the plication. Unfortunately, as has been pointed out, there is always a risk of mesh infection when placing a foreign body. In the interim, it is very difficult to predict whether this will worsen or not, but it is possible. Wearing a binder will help and likely make you feel more comfortable, but it's difficult to say whether it would truly prevent further worsening of the suture failure. Good luck!

What to do when muscle repair fails and comes undone? (Photo)

Answers (7)

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