I Had a Tummy Tuck Without Muscle Repair and Now Regret It. Can It Still Be Done Without a Redo of the Whole TT?

If you have a lot of intraabdominal fat around your intestines and organs as the cause for your protruding stomach, you will see a significant flattening with weight loss. If the bulging is from the muscles being loose, the tightening can help. Tightening the muscles in a patient with a lot of intraabdominal fat does not always flatten the tummy much since the fat inside is pushing against the tightening.

Yes, you can perform a fascial tightening procedure following the tummy tuck but this involves opening almost the entire wound again. This procedure may not give you the flat tummy you desire if you have  a lot of fat inside the abdomen. Try lying down flat and look at your stomach-if it goes very flat, then fascial tightening will work.

Hi and thanks for your question, it is rather difficult to comment on your situation without at least seeing before and after photos and getting some more information from you about your specific concerns.

The rectus muscle plication (muscle repair) is one of the most important components of a good tummy tuck surgery in my opinion. Almost all women, especially if they have had children, will benefit from the rectus plication. In order to do it well, the surgeon needs to be able to have access and visualization of the entire muscle wall. The full tummy tuck surgery provides excellent exposure in order to accomplish this by "peeling back" all of the belly skin during the surgery. Trying to complete the plication through a small incision really doesn't work. So, basically, you have 2 options. Repeat the tummy tuck procedure or allow a surgeon to make a vertical midline scar on your abdomen in order to see the entire length of the muscle. I just don't think that there are any other ways to go about it. Most likely, the cost is going to be similar to your tummy tuck surgery cost. Unless, the surgeon that completed your first surgery would be willing to do it for less.

Absolutely. The technique of endoscopic abdominoplasty is perfect for this. A tiny incision is made near the belly button and a  scope is inserted through the old scar (so there is no need for a new one) and the skin flap lifted up and the muscle is repaired in the usual fashion under endoscopic vision. This is just the same as having your knee scoped or a gallbladder removed with a scope. However, we do not enter your abdominal cavity as all the work is done under the skin so the risk is less than the original procedure since the skin flap risk is eliminated . You need not have any more than a band aid sized incision. I do these on patients who have excellent skin and only need muscle repair or minimal skin excision but it is also perfect for your exact scenario.More information is available on my website. I helped develop this technique in the 90's and have lectured and taught it for many years. I wish more surgeons used it since it is a great tool and makes many long incisions unnecessary. We also are not far from you but you might want to ask your original surgeon first if he offers this technique. Also keep in mind that a round abdomen after tummy tuck could be due to fat that is inside the abdominal cavity in a situation where someone is still overweight. If this is the case then muscle tightening will be less effetive in getting rid of your round tummy. Best of luck to you. 

When an abdominoplasty is performed four components must be assessed:


Skin

Subcutaneous fat

Anterior abdominal wall laxity

Visceral or intra-abdominal fat


In you particular situation if you still have an abdominal bulge that improves when you suck in your abdomen and is not either subcutaneous fat or visceral fat then you may be a candidate for repair of the fascia.  This can be done but will require some re-elevation of the abdominal skin flap and some times it can be difficult to work around the umbilicus without making the umbilical incision again.  

It is unusual that a tummy tuck is done without tightening of the abdominal muscles. If this is not done, it is possible to tighten the muscles without having to make a large incision again. Usually about a 4-6 inch incision can be made in the old tummy tuck scar in the operating room, and a narrow tunnel made over the midline of the abdomen. Then stitches can be placed in this tunnel to tighten up the muscles.

You should also look at your BMI to make sure it's not above 28-30. If it is, then there may be intra abdominal fat pushing out and causing a bulge, especially on the upper abdomen. If so, then the only solution is weight loss.

 

As you can read from my colleagues a Muscle repair helps flattening and tightening your belly. We cannot speculate if you needed or not in the first place.

The fact is that you were told now it would improve what you are unhappy about. The easiest and most straightforward approach is to go through the same incisions. Time wise and effort wise it is about  as much as the first time around. This includes Operating Room and Anesthesia costs.

If you choose a new Plastic Surgeon he most likely will charge his "usual" fee (which maybe similar to what you already paid). Your Surgeon from the original surgery may give you a discount and his prices are at least "negotiable". A lot and not only the financial aspect speaks for you to return to him.

I hope you will be able to enjoy your belly  soon.

I wouldn't want to contribute to second guessing. Absent photos, I can't anyway. 

If laxity of the abdominal wall plays a role in the problem (and I would suppose your plastic surgeon does not so feel), then tightening the abdominal wall may be worth considering. 

It would be done using the same incisions. If your surgery was recent, sooner might be better than later in terms of ease of surgery. 

For fees you would need to discuss with your surgeon, but chances are this would cost less than a TT. All the best. 

Separation of the rectus muscles is repaired with a tummy tuck (abdominoplasty).  If you dod not have separation of the muscles then no tightening was needed.  Over-tightening occurs when the muscles are sutured too close to each other, leading to infolding of the middle edge of each rectus muscle. This can lead to funny ridging and discomfort.

 

Talk to your surgeon: if a separtion was not repaired then it should be redone.