When Does Your Lymphatic System Heal After Tummy Tuck?

Question

I had a full tummy tuck with muscle repair 2 months ago (May 2011). I was just wondering when your lymphatic system returns to normal or if it ever does? What are tips in helping it reconnect and heal? I occasionally use a heating pad on my abdomen and I find it feels nice and I've heard it helps with scar formation. Does it cause any problems with the lymph fluid gathering in my abdomen and swelling? Should I stop this? Thanks for all your answers. I really appreciate it!

Tom J. Pousti, MD · Answer

Thank you for the question.

	Based on observations after tummy tuck surgery, I see improvement in, while swelling occur drastically about 2 to 3 months after the surgery. It may be that lymphatic drainage is improving at about that time.

	Generally, abdominal wall "swelling" after tummy tuck may be related to:

	1. Swelling in the soft tissues.  This may take several months to resolve and may worsen with increased activity  or at the end of the day.   Patience  is required to allow for resolution of the swelling. The swelling occurs because of the interruption of venous and lymphatic channels that occurs during the tummy tuck operation.
	2. Fluid accumulation in the space between the skin and the abdominal wall muscle.  this may consist of blood ( hematoma)  or serum (seroma).  This fluid accumulation can generally be diagnosed by physical examination ( occasionally ultrasound  may be helpful).  Treatment consists of aspiration;  several episodes of aspiration may be necessary. 
	3. Separation of the abdominal wall muscle repair may lead to a swelling/bulge appearance. This may be diagnosed on physical examination  with your surgeon examining you in different bodily positions. One of the steps of a tummy tuck procedure involves reapproximation (plication)  of the rectus muscles.  These muscles have spread apart during pregnancy and/or weight gain. Bringing them together again in the midline helps to &ldquo;tighten&rdquo; the abdominal wall as well as to narrow the waistline.
	4. Residual adipose tissue may be confused for swelling. Again this is most easily diagnosed by physical examination. Additional liposuction surgery maybe necessary to improve the results of surgery.
	Generally, it takes many months for swelling to resolve after tummy tuck surgery and it may take up to one year  (or greater)  a complete skin redraping  to occur.

	I hope this helps.

Camille Cash, MD · Answer

Swelling is common and expected after a tummy tuck.  While the majority of the swelling resolves after the first 8-12 weeks, it can take 9-12 months for complete healing.  The lymphatic system gradually heals over this time as well.  In the beginning especially it is important to monitor regular swelling versus seroma formation.  Your surgeon will monitor your recovery progress at your follow up visits.  It is important to closely follow your surgeon's instructions for optimal healing.

Todd C. Case, MD · Answer

Until the lymphatics regenerate or new ways for the fluid in the soft tissues to get out of the area are developed, you will continue to have swelling in your lower abdomen, above the scar line. You may notice that this swelling is better in the morning when you first get up, but worse at the end of the day before you go to bed. This usually takes three to six months or some times longer to resolve. You can consider manual lymph drainage techniques, wear a compression garment and/ or just let nature run it's course. You should discuss any options with your plastic surgeon before undertaking any them.

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