My surgeon said my muscle repair may have failed. What is the likelihood he is wrong? (photo)

Separation of the muscles after tightening is unusual.  Also if it did occur it probably would have caused excruciating pain.  So it’s  pretty unlikely.  Depending on how long it has been since your procedure there could still be some swelling for a few months.

If you are so early in the process to still have drains odds are you’ll be fine. You have a lot of swelling on board. At this point the treatment is time. Good luck 

I'm not sure what you are showing in this photo, but if your drains are still in, it would be unlikely to have a seroma. During the first week after surgery, the abdominal wall has not sealed back down and any fluid that may be there should be draining via the drains. The time frame for seroma is typically after the drains are out, unless yours are not functioning or there is some other issue. If you have an area of focal swelling that is getting bigger, one possibility early after surgery is a hematoma (collection of blood rather than serous fluid), and these are harder to drain with a needle, especially if it is clotted. The area can also be painful like a bruise, so if there is pain and bruising over the area he tried to drain, you may have a hematoma. If there is clinical suspicion of hematoma, your surgeon could order imaging, or monitor closely if small and not growing, or take you back to surgery to evacuate the hematoma. Without seeing you in person or having more history, it is difficult to say why the surgeon felt you may have popped or loosened sutures. The technique of muscle repair varies, and personally I do a double layer repair, and one layer has a row of interrupted sutures so even if one were to come loose or break, your repair would not be at risk for unraveling altogether. If you only had a single layer repair, and it was a running stitch, then loosening or a tear would have a bigger impact. Regardless, even if that happened, now would not be the best time to go back when you are swollen. Keep close followup with your surgeon, and alert him to any changes you are experiencing. It is normal to have overall swelling during the recovery, but if there is a focal area of swelling, that should be evaluated to make sure no intervention is needed.

By the look of your picture with the drain still in place, it looks like you are still very early out from surgery.  While there is the possibility of having broken the sutures that have tightened the muscle, another possibility would be a hematoma (blood collection) in the muscle that could have been the result of coughing and would also cause a tender bulge.  Often this cannot be drained early on and simply needs to resolve on its own.  An ultrasound could help confirm the diagnosis although a CT scan would likely be more accurate to detect muscle separation/suture failure, but unless there is a plan for intervention based on the results of the imaging study, it is likely to be a waste of time and money at this point.  Instead, it would probably be best to watch the area as you heal and see if it resolves on its own.  Even if the sutures have broken and need to be repaired, most surgeons would recommend waiting several months for the swelling and scar tissue to resolve before taking you back to surgery.  In all likelihood you will be fine, but it's important that you maintain close follow up with your surgeon.  Best of luck with your continued recovery!

Hello,Your photo of your abdomen while seated is not telling. My recommendation is if there is a fullness that is fluctuant (like a water bed), then it's a seroma and it needs to be managed. If not, it is likely swelling. It would be unlikely you have a seroma with drains in place. Fears of muscle repair failure are unwarranted unless you had substantial intra-abdominal fat prior to surgery. Best to be patient. Best of luck!

Dear Bellaanna3,I understand your concern. However, without a proper assessment it would be difficult to determine what is wrong. It is best that you visit a board certified plastic surgeon for further assessment. Only after thorough examination you can get proper recommendations and advice. Daniel Barrett, MD, MHA, MS 
Certified, American Board of Plastic Surgery  
Member, Am. Society of Plastic Surgery

as just a simple exam would do.  I suspect you did not disrupt your sutures (unless your fascia was really of poor quality) and speculate its more likely that you have some excess fat and skin there.  Regardless, if you do not have a seroma (an ultrasound is relatively cheap to determine this), then give it time to heal and when healed, you should let your surgeon know of your concerns and then be provided options from which you can choose to help you get a better outcome.

An USS is often the simplest way to look at swelling. You are best to post some different images for a more informed opinion. You are early postop and it is rare for internal stitches to give way. Perhaps your PS can perform an USS to reassure.

Unfortunately this is something that happens from time to time as the only thing holding your muscles together in the first 2 months are the sutures, which can break.  To know for sure, you can get a CT scan of the abdomen to look at the muscles but with time, your bulge will be more noticable and you can diagnose it purely by looking at your abdomen.  It looks like you had surgery not too long ago so the only thing to do right now is to wait things out.  If your surgeon feels the need to go back and repair the muscles, it will require another surgery but best to wait 6 months before doing anything as if he goes back in soon, he may not be able to close the incision again.  Best of luck!

Without more of a history and information including such issues as how long postoperative you are and the qualifications of your surgeon AND an examination, it is impossible to determine your exact situation. You should consider discussing your concerns with your surgeon in great detail and to your satisfaction. If there is any doubt, you can always seek a second opinion from a reputable board certified plastic surgeon.Steven Turkeltaub, MD