How to Fix a Side of Lower Ab That's Sticking out After Tummy Tuck?

Question

My ab sticks out more on my right side like I was pregnant sometimes. Can it be fixed and was it suppose to be noticed by my surgeon when I went for a full Tummy Tuck?

Steven H. Williams, MD · Answer

Thanks for the question.
It is obvious you're upset with your result. There are several issues.
First - if you are less than three months post-op you should give things additional time to settle down.  Swelling in the lower part of the abdomen is usually the last to leave.  You don't want to have a procedure to fix something that will get better on its own.
If you are more than three to six months out and there are areas of asymmetry (I don't see those from the photos you've posted) it may have to do with incomplete plication of the lower rectus fascia or a ruptured suture.
If the bulge your bothered by is caused by subcutaneous fat some targeted liposuction may improve the situation.
As with the other posters, I agree you should have a serious conversation with your treating plastic surgeon to discuss pre-op goals and how close you've come to achieving them. 
You may also want to consider an exam and consultation with another board certified plastic surgeon.
I hope this helps.

Brent Moelleken, MD · Answer

Many patients are under the impression that their tummies will be flat after a tummy tuck.  This may or may not occur, even in the best of hands.
If there is fat inside the abdomen, it will bulge out, no matter how well the tummy tuck was done.  Fat inside the abdomen is not the fault of the doctor.
Also, there is only so much tightening that can be done on the fascia.  If it is weak and ripped, it can be tightened, but only so much.  The doctor cannot completely tighten all the fascia and reverse all the effects of genetics causing a weak fascia, of pregnancy ripping the fascia circumferentially, of differences from one side to another, etc.  A weak fascia or an asymmetric fascia is not the fault of the doctor.
As all of the other doctors have pointed out, patients must be reasonable about their results.  They cannot be mad at the doctor about uncorrectable aspects of their own body. 
Usually these misunderstandings can be ironed out in the doctor's office with a frank discussion such as the one above.

Otto Joseph Placik, MD · Answer

There are many potential causes for asymmetry in the lower abdomen following tummy tuck that cannot always be predicted nor necessarily prevented.
Prior surgery such as appendenctomy or chlecystecomy or pfannenstiel incisions can cause abdominal wall weakness with resulting muscle laxity and bulging that can produce fullness that is more apprarent on one side following a tummy tuck.

Armando Soto, MD, FACS · Answer

Hi there-
I would agree with Dr. Rand- It's difficult to assess your outcome completely without knowing what you looked like before surgery, and without more photos or an exam, but from the photo you DID post, it looks like you have a reasonable (if not excellent outcome).
I also agree that the bigger problem seems to be your relationship and communication with your surgeon... I would go back and discuss your expectations for surgery with him/her and try to understand why those expectations could not be met. I'm sure your surgeon wants you to be happy as much as you do.

Nicholas Carr, MD · Answer

There are a number of reasons for asymmetry after abdominoplasty. A careful examination by a plastic surgeon should be able to sort them out. The first distinction to be made is whether there is a difference in the thickness of the abdominal wall fat that accounts for it. This can usually be determined by a pinch test comparison. The other common cause is an asymmetry in the way the muscle has been tightened, assuming this was done during your surgery. Less likely causes are a persistent seroma (fluid pocket) or an asymmetry related to your internal organs that is unrelated to surgery.

Michael D. Yates, MD · Answer

A full tummy tuck removes a significant amount of skin and fatty tissue from the lower abdomen and contours the hips, waists, and upper abdomen with liposuction. It is not safe to lipo the lower abdomen at the same time skin is excised, so there is usually at least some residual roundness in the lower tummy. Often there is some difference from side to side for many different reasons. I would not fault your surgeon for this asymmetry. The important thing to know is that the fuller side can be reduced with a small liposuction under local anesthesia. This probably won't fully correct the difference, but will result in some improvement.

Peter A. Aldea, MD · Answer

I agree with Drs. Rand and Soto. Judging by the extent of circumferential stretch marks of the thighs, buttocks and belly and the residual amount of fat under the flaps, you must have had moderate to significant obesity and poor skin tone before  your surgery.  You do not provide a BEFORE photo but from this single AFTER , you APPEAR to have a very reasonable result.
It is only left to me to ASSUME that MAYBE you were expecting much more than could be physically delivered with this operation. You should discuss this with your surgeon and reach an understanding and a plan of what can or cannot be done in the future once this is healed.
Dr. P. Aldea

Darryl J. Blinski, MD · Answer

Two postings! You need to see another board certified plastic surgeon. With your issues you need to be examined and discuss your options. Regards.

Richard P. Rand, MD, FACS (retired) · Answer

Dear Blue44 again,  
As you have 2 posts today, it is clear you aren't happy and have some raport problems with your doctor.  I really don't see in your photo what you are questioning however.   You really need to go back and have a good conversation about your preop expectations because while we don't know what you looked like preop, based on what photos you have shown, it looks like a reasonable TT was performed.

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