I've had a mini tummy tuck and still have a huge bulge. What happened? And, what next? (photo)

I had triplets 27 mos. ago and had severe diastasis recti, w/ minimal extra skin. My plastic surgeon recommended a mini TT, with the understanding I'd still be left with a little extra skin and keep my "old" belly button in tact. I had it done 18 mos. after delivery. I'm now 9 mos. post TT and still have this huge bulge. What is causing it? I have a tall slender build, at 5'11" and 140 lbs, was a HS and college athlete, and still very active. What are my options to get rid of this? Thanks!

Doctor Answers 6

Mini Tummy Tuck vs. Full Tummy Tuck

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Unfortunately, patients with significant rectus diastasis both above and below the belly button are typically not great candidates for a mini tummy tuck procedure. The reason for this is that although you may not have had significant excess skin, a mini tummy tuck only allows for the muscles below the belly button to be addressed- not above. In order to achieve a flat, sculpted appearance, it appears that you would require a full abdominoplasty. During this procedure, not only would additional skin be removed between the belly button and pubic hair line, but the muscles both above and below the belly button would be pulled together to create a desirable tight, flat abdomen. It may be advantageous to obtain a second opinion from a board certified plastic surgeon as an in-person physical examination is key to determining a definitive treatment plan to address your concerns. 

I've had a mini tummy tuck and still have a huge bulge. What happened? And, what next?

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Hi. Triplets.....wow. What you are witnessing is the tremendous stretch that the pregnancy placed on your abdomen. Not only was your skin stretched to the max, but as you noted, the muscles were greatly affected also (rectus diastasis). I am not aware of discussions between you and your surgeon but with all due respect to your surgeon a mini-tummy tuck was not the indicated procedure for you. You should have had a full tummy tuck with complete plication ( repair) of the rectus diastasis.

It appears from your photos that a full tummy tuck could still be performed. You have a nice long distance from your belly button to the end of your breast bone, called the xyphoid. This will allow all of the skin below the belly button to be removed and in addition give access for the muscle repair to correct the"balloon effect". I would get a second opinion because IMHO the situation can be greatly improved.

Always seek out the opinion of a surgeon certified by the American Board of Plastic Surgery with years of experience in tummy tucks. Furthermore request to see before and after photos of previous patients by that doctor....not a clinic or surgery center. Do your homework......research and verify the doctor's credentials. Have they had problems with the Board of Medicine, disciplinary or otherwise. Any law suits?

How about the center, clinic or facility? Are they accredited by a national organization or do they just have State approval. Understand that at the current time, there are three nationally recognized organizations responsible for the highest levels of patient safety, AAAASF, AAACH and JCHO. You owe it to yourself to position yourself for the best possible results but under the most stringent safety regulations, If you have kids, even more so.

How about anesthesia? Will you have a medical doctor certified by the American Board of Anesthesiology or a certified nurse anesthetist (CRNA)? Understand that there is no substitute for research. Cosmetic surgery, no matter how simple it may be to the patients, are invasive procedures and as such carry certain risks and complications. I hope the info provided has been helpful.

In our office we use TouchMD which is a web based program in which patients have the ability to load their picture unto the program. I then evaluate them and can actually draw on the picture to show a potential patient where the incisions would be located and how the procedure is to be realized. It's all done to comply with HIPPA which is the federal law that protects the patient's medical information. Look them up.

Give yourself the highest percentage of a sucssesful operation. Good luck

I've had a mini tummy tuck and still have a huge bulge. What happened? And, what next?

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For 99+% of patients, a mini-tummy tuck is an exercise of wasted time, wasted money and frustration. It produces very little result and is typically done by non-plastic surgeons.  In your case, it was 100% predictable that you would have little to no result from a mini-tummy tuck.  After triplets, your wall was stretched out is a big way (skin too).    

You can absolutely have a tummy tuck and achieve a much improved result. 
Good luck.

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Bulging after a mini tummy tuck

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You didn't have much or any repair of the abdominal musculofascial wall that is inherent and necessary in most abdominoplasties or tummy tucks. You can excise limited lower skin in a case like yours, but without tightening of the muscular fascial abominal wall, you see what you sacrifice in final results - that is unless for some reason, your repair stretched out significantly, which I doubt but can happen. In tightening the abdominal wall to the degree that it needs without much or any upper abdominal skin, I'd include most likely an umbilical translocation ( moving the belly button down 1.5in ) or maybe a conversion to a full tummy tuck, but  only if enough skin to advance. All fixable. 

Non candidate for Mini Abdominoplasty?

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You appear to not be a candidate for mini abdominoplasty.   With a large diastasis  recti you need a full tummy tuck with skin excision, fat excision, umbilical transposition, liposuction and repair of the rectus from the rib cage to the pubis.    You are a great candid for a full 100% tummy tuck.   Mini procedures are okay but mini means mini results in some patients.   Mini procedures satisfy patients with mini expectations.    My Best,  Dr C

Still with abdominal issues

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Thank you for your pictures. It looks like you still have significant laxity of the muscle wall from your pregnancy. You're going to need either of two things one a full tummy tuck with relocation of your bellybutton scar lower or an endoscopic tummy tuck. 

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.