Failure of muscle repair? (Photo)

Question

So I am 6 months out from full tummy tuck and I feel my sutures may have failed to hold in my muscle repair. I have more of a bulge now above my belly button than prior to surgery. I was 124lbs before and 122 lbs now I feel like I am not happy and waster 10k thoughts??

Ajaya Kashyap, MD · Answer

Thank you for your query! You do have a bulge in the upper part of your abdomen.  It is difficult to say if it is because of fat or a weakness/bulge between the muscles. If you were to feel the muscles of your abdomen while  lifting your self up from a laying down position, you will  be able to feel a space in the midline  between the muscles , if the repair has given way. An ultrasound could further diagnose the issue. You should discuss your concerns with your Plastic surgeon who should be able to figure out the problem on a physical examination. All the best!.

Yily De Los Santos, MD · Answer

Thank you for your question and pictures. You are a great candidate for a second Tummy Tuck and liposuction with fat transfer.

If you're willing to travel, Surgeons in the Dominican Republic have experience and very high standard of excellence when it comes to plastic surgery. I'm positive you can get what you're looking for

Daniel Barrett, MD · Answer

Dear Dynamic7229,
I understand your concern. However, without a proper assessment, it would be difficult to determine what went wrong. It is best that you visit your plastic surgeon for further assessment or ask for a second opinion. Only after a thorough examination, you can get proper recommendations and advice.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Camille Cash, MD · Answer

From your photo and description it sounds as if either the muscle repair was not performed or it may have failed.  An examination is needed to determine what may be occurring.  I encourage you to visit with your surgeon for an assessment.

Darryl J. Blinski, MD · Answer

Based on the nicely posted photos you can not be sure if you have a "failed muscle/rect plication"... Only was is ultrasound examination of the abdomen. I offer in office ultrasound at a fee. Or obtain RX and seek one in local hospital or Radiology center. If the ultrasound demonstrates muscle separation then re operation can offer better flat effect. Redo fee $8,000+. Best t virtual consult with......

Mats Hagstrom, MD (license on probation) · Answer

To make an assessment on the outcome of a plastic surgery procedure we always need to see proper before and after pictures. If you don’t have before and after pictures, don’t ask your surgeon to forward the ones they took. The number one reason patients have a domino bulging after a full tummy tuck is due to having excess visceral or intra-abdominal fat. There are four tissue variables that determine what the abdomen looks like. If somebody doesn’t like the way they were the problem is always related to one or more of those four tissue variables. 
The four tissue variables that determine what the abdomen looks like are abdominal skin laxity, excess subcutaneous fat, muscle separation from previous pregnancy, and excess visceral or intra-abdominal fat.
Insufficient muscle tightening can also be a cause, but this tents to be uncommon, especially compared to under recognized visceral fat and how much this can impact the outcome of the procedure.
The easiest way to differentiate visceral fat versus muscle separation is to see what you abdomen looks like when you lay on your back. If your abdomen. Try laying on your back and see if your abdomen goes completely flat. If it does, then insufficient, muscle tightening is most likely the best explanation. If your abdomen still bulges, while laying on your back then excess visceral fat is most likely the explanation. why you still bulge after the procedure. 
Excess visceral fat can usually be seen on before pictures and should’ve been assessed during your consultation.
Visceral fat can only be reduced through weight loss. The amount of visceral fat is determined genetically.
Individuals who have excess visceral fat, are going to have limited results in regards to getting a flat of them in from a full tummy tuck, unless the visceral fat is addressed before or after the procedure.
Obviously, both variables can contribute and insufficient muscle tightening and excess visceral fat may in fact be what’s going on. It’s important to differentiate between the two because the solution is going to be different depending on what the problem is.
Assessing the degree that visceral, fat or insufficient muscle tightening impacts the outcome of the procedure should be all that difficult. Most plastic surgeons should be able to help you with this. To do it accurately will require an examination. I suggest having a few in person, a second opinion, consultations with other local board-certified plastic surgeons. Come prepared for a second opinion consultations by bringing with you all proper before and after pictures and a copy of your operative report. These are all available from your surgeons office if you request them.
Best,
Mats Hagstrom, MD

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