What caused my failed muscle repair six months after TT? Is the second repair likely to fail? (Photo)

I have no idea why an abdominal wall repair would fail six months after abdominoplasty. There may be some underlying connective tissue issue such as Ehlers Danlos syndrome.

There are several factors that can explain your situation.  First, there is a limit to the strength of the abdominal wall fascia (the top layer which is sutured together).  Sometimes this layer is sutured as tightly as possible but "gives back."  This situation is basically genetic.  Second, every time the abdomen is tightened the surgeon must use judgment to determine "how tight" to pull.  Perhaps you can be further tightened.  For that layer I use non-dissolving sutures.  Finally, early exercise or weight gain can stretch out the repair.  Best of luck!

Thank you for the pictures -- however, it is still difficult to assess if there truly is a failed muscle repair or not.  Your surgeon has to give you a thorough examination lying down, and also bearing down to evaluate the integrity of the muscle plication (i.e. the muscle tightening repair with stitches).  However, if there is a doubt, the only definitive way to check the muscle repair is with an imaging study (CT or MRI).  In terms of your future outcome after this next surgery -- your muscle may just be thin, in general, and a little bit of stomach muscle laxity may be inevitable.  I'm not exactly sure what you mean by clamps, but some surgeons may use a mesh support during the surgery.  Your post-operative outcome can also be improved with strict adherence to your surgeon's post-operative activity recommendations (including abdominal binder use), and then a careful abdominal muscle strengthening program once you are completely healed from the surgery -- at least 6 weeks out.  Of course, make sure you maintain good nutrition and refrain from any smoking (if you are a smoker).Good luck.

Some patients have very thin, weak fascia that doesn't hold suture well. These patients tend to loosen up over time causing recurrent bulging. When redoing, it is sometimes good to put a supporting mesh to strengthen the repair.

Not sure you HAD a failed MR??? Did you have a scan to see if repair failed? Plus either re post better photos or seek in person second opinions... 

There is a trend right now to use an absorbable barbed suture for the rectus repair.  If your own tissues were weak and the rectus didn't heal by the time the sutures dissolved, that may be a reason.  Make sure your plastic surgeon is using a permanent suture for your repeat procedure.

by 6 months out you should be strong enough in that area so the repair should have held. The question for me would be how was it doing at 2,3 months out. In other words were you doing too much and felt pulling or discomfort but continued though it?? Were dissolvable sutures used rather than permanent. How were your tissues when repaired, i.e. did they seem strong enough?? If not, than an ADM like Seri, can be used to help support the tissues. Unfortunately it is not always clear why, just that it happened. Not sure what clamps mean?? I would probably do multiple layers of repair, and with interrupted rather than running sutures as well. I would have you wear the garment longer, and be really careful with twisting and activities for a longer period of time, just to be safe. good luck. 

None of what you mentioned sounds "right".  I strongly recommend getting a second opinion from one or more other board certified plastic surgeons and taking the operative reports from your previous surgeries to those consultations for the other surgeons to review.