Why is my lower abdomen not flat 4 months post op full tummy tuck with muscle repair? (photo)

 Although your concerns are understandable, what you describe is commonly encountered after this procedure. Patients will like their “flatness” immediately after surgery; then, these same patients are disappointed for a period of time once swelling of the tissues occurs. In the longer term (this may take several months and even up to one year), the swelling dissipates and the skin of the abdominal wall "redrapes"  over the smaller underlying  musculoskeletal framework (where the abdominal wall muscles have been brought together again in the midline).Generally speaking, 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. On one side to hear about your concerns after bus stop when patients are2. 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.  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 “tighten” 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.
  Best wishes. 

Hello. Great question. Thank you for your images, However, a personal examination is needed to determine if your bulge is swelling, fat or seroma.

Dear proudmommyoffour,
I understand your concern and it is quite normal to be concerned about the outcome following a tummy tuck surgery. However, you are still in the very early stages of the healing process.Your will need to be patient at this moment and follow what your surgeon has instructed you to do post operatively.At the early stage of the healing process, the tissues are still swollen. Once the swelling subsides  you will be able to see the final result of your surgery.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery